MEDICARE: KATHLEEN ALLYS WOOD PTA

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	225200000X	Physical Therapy Assistant	2059087	TX

General Provider Information

NPI Number	:	1932430162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN ALLYS WOOD PTA

Provider Business Mailing Address
First Line	:	9115 MELODY PARK LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77044-5377
Country	:	US
Telephone Number	:	281-796-7641
Fax Number	:

Provider Business Practice Location Address
First Line	:	5514 ATASCOCITA RD
Second Line	:	SUITE 160
City	:	HUMBLE
State	:	TX
Zip	:	77346-2968
Country	:	US
Telephone Number	:	281-441-5371
Fax Number	:

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

Provider Enumeration Date	:	01/28/2010
Last Update Date	:	01/23/2020

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