Healthcare Provider Details

I. General information

NPI: 1598000614
Provider Name (Legal Business Name): JEROME SCOTT WOODWARD PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6660 TIMBERLINE RD SUITE 100
HIGHLANDS RANCH CO
80130-5345
US

IV. Provider business mailing address

7310 S ALTON WAY SUITE 6L
CENTENNIAL CO
80112-2334
US

V. Phone/Fax

Practice location:
  • Phone: 303-683-4500
  • Fax: 303-683-4515
Mailing address:
  • Phone: 303-790-4495
  • Fax: 303-488-1988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: