Provider Demographics
NPI:1942462403
Name:WOODWARD, JEREMY DUSTIN (PT, DPT, MS)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:DUSTIN
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:PT, DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1025
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-0041
Mailing Address - Country:US
Mailing Address - Phone:270-908-0294
Mailing Address - Fax:270-908-0296
Practice Address - Street 1:127 ALBEN BARKLEY DR
Practice Address - Street 2:SUITE C
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4402
Practice Address - Country:US
Practice Address - Phone:270-908-0294
Practice Address - Fax:270-908-0296
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005283225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist