Healthcare Provider Details

I. General information

NPI: 1962511865
Provider Name (Legal Business Name): MICHAEL JAMES WOOD PT, MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N PERRYVILLE RD PHYSICAL THERAPY DEPT
ROCKFORD IL
61114-8011
US

IV. Provider business mailing address

2662 MCFARLAND RD ATT. CHRIS LABONTE, RMH-MED STAFF
ROCKFORD IL
61107-6806
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-2000
  • Fax: 815-971-9109
Mailing address:
  • Phone: 815-971-2248
  • Fax: 815-968-9340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-015242
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: