Provider Demographics
NPI:1013081348
Name:WOOD REHAB AND FITNESS LLC
Entity Type:Organization
Organization Name:WOOD REHAB AND FITNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-845-2500
Mailing Address - Street 1:132 N LAFAYETTE AVENUE
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041
Mailing Address - Country:US
Mailing Address - Phone:304-845-9550
Mailing Address - Fax:304-845-9540
Practice Address - Street 1:132 N LAFAYETTE AVENUE
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041
Practice Address - Country:US
Practice Address - Phone:304-845-9550
Practice Address - Fax:304-845-9540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4000334000Medicaid
WV4000334000Medicaid