Provider Demographics
NPI:1205954690
Name:WOOD, PAMELA ANN (PT)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ANN
Last Name:WOOD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S BARTON ST
Mailing Address - Street 2:#147
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-4851
Mailing Address - Country:US
Mailing Address - Phone:703-979-5468
Mailing Address - Fax:
Practice Address - Street 1:4141 N HENDERSON RD
Practice Address - Street 2:PLAZA 8
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-2486
Practice Address - Country:US
Practice Address - Phone:703-527-8446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2305002036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG01684H01Medicare ID - Type Unspecified