Provider Demographics
NPI:1982063517
Name:WOODRUFF, RENEE (LMT)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:READING CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14876-0036
Mailing Address - Country:US
Mailing Address - Phone:315-681-3207
Mailing Address - Fax:
Practice Address - Street 1:4044 STATE ROUTE 14A
Practice Address - Street 2:
Practice Address - City:READING CENTER
Practice Address - State:NY
Practice Address - Zip Code:14876
Practice Address - Country:US
Practice Address - Phone:315-681-3207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0263221225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist