Healthcare Provider Details

I. General information

NPI: 1356487243
Provider Name (Legal Business Name): DIANA LYNN WOODIEL MS, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WILSON LOOP
WARD AR
72176
US

IV. Provider business mailing address

33 LILAC LN
CABOT AR
72023-8182
US

V. Phone/Fax

Practice location:
  • Phone: 501-941-5630
  • Fax: 501-843-2270
Mailing address:
  • Phone: 501-912-6401
  • Fax: 501-843-2270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2185
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: