MEDICARE: CAROLYN WOODS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	PTA27978	FL

General Provider Information

NPI Number	:	1003449760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN WOODS

Provider Business Mailing Address
First Line	:	1045 STEVENS AVE
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1945 BAY RD
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-2105
Country	:	US
Telephone Number	:	352-483-5633
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2020
Last Update Date	:	02/20/2020

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Directions to “ CAROLYN WOODS ” Practice Location

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