Provider Demographics
NPI:1881105773
Name:WOOD, TERRY ALLEN (RRT, RPSGT, BCB)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:ALLEN
Last Name:WOOD
Suffix:
Gender:M
Credentials:RRT, RPSGT, BCB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17601 WRIGHTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4953
Mailing Address - Country:US
Mailing Address - Phone:714-486-7793
Mailing Address - Fax:
Practice Address - Street 1:24541 PACIFIC PARK DR
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3065
Practice Address - Country:US
Practice Address - Phone:949-427-0999
Practice Address - Fax:949-446-0585
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120052227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGroup - Multi-Specialty