Provider Demographics
NPI:1518370352
Name:WOODRUFF, PAUL A (MED, PT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:A
Last Name:WOODRUFF
Suffix:
Gender:M
Credentials:MED, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 WOLCOTT ST
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-6250
Mailing Address - Country:US
Mailing Address - Phone:802-879-2884
Mailing Address - Fax:
Practice Address - Street 1:81 WOLCOTT ST
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-6250
Practice Address - Country:US
Practice Address - Phone:802-879-2884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.00010512251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics