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General NPI Number Information
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NPI Number | 1740893395
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Entity Type | Individual
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Provider Name | JUSTICE WOODS MS, ATC, CES
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Gender | Male
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Dates
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Enumeration Date | 08/24/2020
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Last Update Date | 08/24/2020
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Provider Practice Location Address
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Address Line | 601 GIRARD ST NW
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City | WASHINGTON
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State | DC
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Zip | 20059-0001
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Country | US
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Telephone | 202-806-7141
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Fax |
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Provider Business Mailing Address
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Address Line | 10914 GEORGIA AVE APT 431
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City | SILVER SPRING
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State | MD
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Zip | 20902-4404
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Country | US
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Telephone | 206-499-4492
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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 | 2000032353
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License Number State | TX
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