Healthcare Provider Details

I. General information

NPI: 1295495810
Provider Name (Legal Business Name): SCOTT WOODBURY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 01/23/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 PLEASANT HILL RD STE 101
DULUTH GA
30096-3268
US

IV. Provider business mailing address

6445 LUZON AVE NW APT 118
WASHINGTON DC
20012-3029
US

V. Phone/Fax

Practice location:
  • Phone: 770-813-5575
  • Fax:
Mailing address:
  • Phone: 240-994-6562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT210002194
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP039611T
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: