Provider Demographics
NPI:1952516114
Name:WOODS, BRANDI CHANELLE (PTA)
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:CHANELLE
Last Name:WOODS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:BRANDI
Other - Middle Name:CHANELLE
Other - Last Name:CHRISTIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:11000 NW 102ND ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-8398
Mailing Address - Country:US
Mailing Address - Phone:405-283-0285
Mailing Address - Fax:
Practice Address - Street 1:6400 N SANTA FE AVE
Practice Address - Street 2:STE. B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9126
Practice Address - Country:US
Practice Address - Phone:405-840-2903
Practice Address - Fax:405-840-3256
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK804225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant