Healthcare Provider Details

I. General information

NPI: 1003233768
Provider Name (Legal Business Name): KATHLEEN WOODCOCK LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 LOWRY ST
PITTSFIELD IL
62363-1768
US

IV. Provider business mailing address

610 LOWRY ST
PITTSFIELD IL
62363-1768
US

V. Phone/Fax

Practice location:
  • Phone: 217-285-5200
  • Fax: 217-285-5212
Mailing address:
  • Phone: 217-285-5200
  • Fax: 217-285-5212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160000211
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: