Healthcare Provider Details

I. General information

NPI: 1598902736
Provider Name (Legal Business Name): LAYLA D WOOD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 POST OAK BLVD STE 1200
HOUSTON TX
77056-6510
US

IV. Provider business mailing address

12323 GERSHWIN OAK ST
HOUSTON TX
77089-5722
US

V. Phone/Fax

Practice location:
  • Phone: 713-965-9998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number2054182
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: