Healthcare Provider Details

I. General information

NPI: 1912206376
Provider Name (Legal Business Name): DEANNA BANDINI WOOD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 SCARBOROUGH DR STE 200
COLORADO SPRINGS CO
80920-7513
US

IV. Provider business mailing address

6340 TIMBER BLUFF PT APT 201
COLORADO SPRINGS CO
80918-6210
US

V. Phone/Fax

Practice location:
  • Phone: 719-630-7500
  • Fax:
Mailing address:
  • Phone: 727-487-4406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number20724
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: