=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376539932
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOOD ASSOCIATES PHYSICAL THERAPY,INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2005
-----------------------------------------------------
Last Update Date | 09/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 799 CONCORD AVE
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02138-1048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-864-4200
-----------------------------------------------------
Fax | 617-491-7368
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 799 CONCORD AVE
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02138-1048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-864-4200
-----------------------------------------------------
Fax | 617-491-7368
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LAURA BETH WILCZEWSKI
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 617-864-4200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------