Healthcare Provider Details

I. General information

NPI: 1770416414
Provider Name (Legal Business Name): BRETT WOODS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 REWAK DR STE 106
FAIRBANKS AK
99709-5024
US

IV. Provider business mailing address

3410 NE 54TH ST
VANCOUVER WA
98661-2025
US

V. Phone/Fax

Practice location:
  • Phone: 907-457-5322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number248019
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number248019
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: