Healthcare Provider Details

I. General information

NPI: 1336391069
Provider Name (Legal Business Name): KRISTY L WOOD P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 10/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 ALTA VISTA ST
SANTA FE NM
87505-4149
US

IV. Provider business mailing address

4423 LOREN AVE NW
ALBUQUERQUE NM
87114-6538
US

V. Phone/Fax

Practice location:
  • Phone: 505-467-2504
  • Fax:
Mailing address:
  • Phone: 505-850-2068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2877
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: