Healthcare Provider Details

I. General information

NPI: 1649158676
Provider Name (Legal Business Name): EMMA LYNN WOODBURY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13105 SCHAVEY RD STE 5
DEWITT MI
48820
US

IV. Provider business mailing address

7748 W. HENDERSON ROAD
ELSIE MI
48831
US

V. Phone/Fax

Practice location:
  • Phone: 517-853-6800
  • Fax:
Mailing address:
  • Phone: 989-640-4729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502008748
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: