Provider Demographics
NPI:1649605908
Name:WOODY, BRIANNA MARIE (ATC, LAT)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MARIE
Last Name:WOODY
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19218 DAVINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-1012
Mailing Address - Country:US
Mailing Address - Phone:216-906-7730
Mailing Address - Fax:
Practice Address - Street 1:16761 SOUTHPARK CTR
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-9302
Practice Address - Country:US
Practice Address - Phone:440-878-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT004210390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program