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General NPI Number Information
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NPI Number | 1346717717
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Entity Type | Individual
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Provider Name | KYLE WILLIAM WOODWARD MS, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 10/24/2018
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 4600 4TH ST N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33703-3802
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Country | US
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Telephone | 727-527-5272
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Fax |
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Provider Business Mailing Address
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Address Line | 2737 12TH ST N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33704-2643
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Country | US
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Telephone | 727-623-1503
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL5723
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License Number State | FL
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