Healthcare Provider Details

I. General information

NPI: 1013486315
Provider Name (Legal Business Name): AISHA DOMINIQUE WOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 US 70 BUSINESS HWY EAST
SMITHFIELD NC
27577
US

IV. Provider business mailing address

1213 PULLEY GORDON RD
ZEBULON NC
27597-8896
US

V. Phone/Fax

Practice location:
  • Phone: 919-553-3259
  • Fax:
Mailing address:
  • Phone: 518-681-2336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP20377
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: