Healthcare Provider Details

I. General information

NPI: 1164103164
Provider Name (Legal Business Name): ADAM WOODHEAD DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PLATINUM PT
LAKE MARY FL
32746-4871
US

IV. Provider business mailing address

3029 ISOLA BELLA BLVD FL 32757
MOUNT DORA FL
32757-6524
US

V. Phone/Fax

Practice location:
  • Phone: 407-206-4590
  • Fax:
Mailing address:
  • Phone: 774-254-7022
  • Fax:

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: