Provider Demographics
NPI:1932194180
Name:WOODSON, STEVEN JOSEPH (MPT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JOSEPH
Last Name:WOODSON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 BLACKBERRY LN
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561-4450
Mailing Address - Country:US
Mailing Address - Phone:603-444-2574
Mailing Address - Fax:603-444-2574
Practice Address - Street 1:260 BLACKBERRY LN
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-4450
Practice Address - Country:US
Practice Address - Phone:603-444-2574
Practice Address - Fax:603-444-2574
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2008-01-15
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00682800225100000X
NH3218225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30396208Medicaid
NJ070451Medicare ID - Type UnspecifiedFACILITY
NH30396208Medicaid