Healthcare Provider Details

I. General information

NPI: 1942638432
Provider Name (Legal Business Name): REBECCA WOOD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 COMMUNITY DR
MARION OH
43302-6487
US

IV. Provider business mailing address

175 COMMUNITY DR
MARION OH
43302-6487
US

V. Phone/Fax

Practice location:
  • Phone: 740-387-7537
  • Fax: 740-383-2866
Mailing address:
  • Phone: 740-387-7537
  • Fax: 740-383-2866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA5615
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: