Provider Demographics
NPI:1952659138
Name:WOOD, REBECCA COLBY (LMT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:COLBY
Last Name:WOOD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:JOHANNA
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3710
Mailing Address - Country:US
Mailing Address - Phone:281-389-8303
Mailing Address - Fax:
Practice Address - Street 1:4314 PINE BREEZE DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77345-1239
Practice Address - Country:US
Practice Address - Phone:281-389-8303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107867225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist