Healthcare Provider Details

I. General information

NPI: 1124095005
Provider Name (Legal Business Name): DENNIS DURWOOD WOOD M.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 VILLAGE PARK DR STE 105
GREENSBORO GA
30642-5101
US

IV. Provider business mailing address

1001 VILLAGE PARK DR STE 105
GREENSBORO GA
30642-5101
US

V. Phone/Fax

Practice location:
  • Phone: 706-454-2000
  • Fax: 706-454-0806
Mailing address:
  • Phone: 706-454-2000
  • Fax: 706-454-0806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6989
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: