Provider Demographics
NPI:1982867222
Name:WOODARD, AUDREY (LMT)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:WOODARD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 ORISKANY BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-1317
Mailing Address - Country:US
Mailing Address - Phone:315-768-8521
Mailing Address - Fax:315-768-7882
Practice Address - Street 1:34 ORISKANY BLVD
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:NY
Practice Address - Zip Code:13492-1317
Practice Address - Country:US
Practice Address - Phone:315-768-8521
Practice Address - Fax:315-768-7882
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011365172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist