Healthcare Provider Details

I. General information

NPI: 1073158036
Provider Name (Legal Business Name): SHONA WOODS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 HARVEY RD
LONDONDERRY NH
03053-7449
US

IV. Provider business mailing address

15 FLEETWOOD DR
WINFIELD KS
67156-5429
US

V. Phone/Fax

Practice location:
  • Phone: 800-657-6517
  • Fax:
Mailing address:
  • Phone: 620-262-7078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1101617
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: