MEDICARE: MR. ADAM WOODEN MPT

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	PT 36691	CA
2	225100000X	Physical Therapist	PT030387	PA

General Provider Information

NPI Number	:	1689991986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ADAM WOODEN MPT

Provider Business Mailing Address
First Line	:	170 N POINTE BLVD
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17601-4132
Country	:	US
Telephone Number	:	717-299-4871
Fax Number	:	717-391-2494

Provider Business Practice Location Address
First Line	:	1701 CORNWALL RD STE 200
Second Line	:
City	:	LEBANON
State	:	PA
Zip	:	17042-7480
Country	:	US
Telephone Number	:	717-299-4871
Fax Number	:	717-391-2494

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

Provider Enumeration Date	:	04/26/2010
Last Update Date	:	06/15/2022

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