Healthcare Provider Details

I. General information

NPI: 1598969958
Provider Name (Legal Business Name): CHRISTINE DELORES WOOD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 COLLEGE AVE
COLUMBUS OH
43209-2827
US

IV. Provider business mailing address

7752 WORLEY DR
BLACKLICK OH
43004-9185
US

V. Phone/Fax

Practice location:
  • Phone: 614-559-0270
  • Fax:
Mailing address:
  • Phone: 614-575-8219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3965
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: