Healthcare Provider Details

I. General information

NPI: 1073746145
Provider Name (Legal Business Name): GAYLA E WOOD P.T.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 N MISSOURI ST SUITE D
MACON MO
63552-2164
US

IV. Provider business mailing address

PO BOX 381
MACON MO
63552-0381
US

V. Phone/Fax

Practice location:
  • Phone: 660-385-6540
  • Fax: 660-385-6542
Mailing address:
  • Phone: 660-385-6540
  • Fax: 660-385-6542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2001009510
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: