MEDICARE: MR. MATTHEW S WOODRUFF M.S., ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician		MI

General Provider Information

NPI Number	:	1043360720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW S WOODRUFF M.S., ATC

Provider Business Mailing Address
First Line	:	2364 REDBUD DR
Second Line	:
City	:	HOWELL
State	:	MI
Zip	:	48855-6410
Country	:	US
Telephone Number	:	517-546-2112
Fax Number	:

Provider Business Practice Location Address
First Line	:	2364 REDBUD DR
Second Line	:
City	:	HOWELL
State	:	MI
Zip	:	48855-6410
Country	:	US
Telephone Number	:	517-546-2112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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