MEDICARE: TODD EDWARD WOOD P.T.

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	225100000X	Physical Therapist	PT17089	CA

General Provider Information

NPI Number	:	1073541140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD EDWARD WOOD P.T.

Provider Business Mailing Address
First Line	:	22038 OLD 44 DR
Second Line	:
City	:	PALO CEDRO
State	:	CA
Zip	:	96073-8707
Country	:	US
Telephone Number	:	530-221-9952
Fax Number	:	530-221-9954

Provider Business Practice Location Address
First Line	:	22038 OLD 44 DR
Second Line	:
City	:	PALO CEDRO
State	:	CA
Zip	:	96073-8707
Country	:	US
Telephone Number	:	530-275-0777
Fax Number	:	530-275-8779

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	01/12/2017

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Directions to “ TODD EDWARD WOOD P.T.” Practice Location

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