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General NPI Number Information
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NPI Number | 1871237412
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Entity Type | Individual
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Provider Name | ANDREA LYNN WOOD
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Gender | Female
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Dates
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Enumeration Date | 04/20/2022
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Last Update Date | 04/20/2022
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Provider Practice Location Address
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Address Line | 28 S MAIN ST
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City | CHESHIRE
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State | CT
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Zip | 06410-3163
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Country | US
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Telephone | 203-271-3296
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Fax |
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Provider Business Mailing Address
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Address Line | 7 BRONSON RD
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City | PROSPECT
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State | CT
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Zip | 06712-1002
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Country | US
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Telephone | 203-800-1313
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 003995
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License Number State | CT
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