Provider Demographics
NPI:1952333502
Name:WOOD, KAHARI TAMON (MSPT)
Entity Type:Individual
Prefix:MR
First Name:KAHARI
Middle Name:TAMON
Last Name:WOOD
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2531 SW FONDURA RD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2773
Mailing Address - Country:US
Mailing Address - Phone:772-348-4272
Mailing Address - Fax:772-348-4612
Practice Address - Street 1:2531 SW FONDURA RD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2773
Practice Address - Country:US
Practice Address - Phone:772-348-4272
Practice Address - Fax:772-348-4612
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21707225100000X
FL225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty