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General NPI Number Information
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NPI Number | 1457652703
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Entity Type | Organization
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Legal Business Name | GLENN WOOD MD PA
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Dates
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Enumeration Date | 11/03/2010
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Last Update Date | 11/03/2010
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Provider Practice Location Address
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Address Line | 2621 RIDGEPOINT DR SUITE 130
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City | AUSTIN
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State | TX
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Zip | 78754-5232
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Country | US
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Telephone | 512-583-9600
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Fax |
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Provider Business Mailing Address
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Address Line | 9411 N LAMAR BLVD
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City | AUSTIN
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State | TX
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Zip | 78753-4178
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Country | US
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Telephone | 512-977-6000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GLENN WOOD
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Credential | MD
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Telephone | 512-583-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 558670000
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | K4012
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License Number State | TX
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