Healthcare Provider Details

I. General information

NPI: 1689728420
Provider Name (Legal Business Name): ELAINE F WOIDKE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W LODGE DR
TEMPE AZ
85283-3652
US

IV. Provider business mailing address

2435 W PAMPA CIR
MESA AZ
85202-7851
US

V. Phone/Fax

Practice location:
  • Phone: 480-730-4103
  • Fax: 480-897-0014
Mailing address:
  • Phone: 480-201-5275
  • Fax: 480-897-0014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1096
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: