Healthcare Provider Details

I. General information

NPI: 1447480132
Provider Name (Legal Business Name): GLENN WOOD MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 08/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 RIDGEPOINT DR STE 130
AUSTIN TX
78754-5224
US

IV. Provider business mailing address

6705 W HWY 290 C1
AUSTIN TX
78735-8400
US

V. Phone/Fax

Practice location:
  • Phone: 512-892-7200
  • Fax:
Mailing address:
  • Phone: 512-892-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. GLENN WOOD
Title or Position: OWNER
Credential: MD
Phone: 512-892-7200