Healthcare Provider Details

I. General information

NPI: 1740653237
Provider Name (Legal Business Name): UNWOD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 S WOODBURN DR SUITE 101
DOTHAN AL
36305-1195
US

IV. Provider business mailing address

131 S WOODBURN DR SUITE 101
DOTHAN AL
36305-1195
US

V. Phone/Fax

Practice location:
  • Phone: 334-791-6920
  • Fax: 334-460-2300
Mailing address:
  • Phone: 334-791-6920
  • Fax: 334-460-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPTH3067
License Number StateAL

VIII. Authorized Official

Name: CHRISTOPHER WASH
Title or Position: OWNER
Credential:
Phone: 334-791-9651