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NPI Code Detail

MEDICARE: MICHAEL WOODARD PT, DPT

MEDICARE: MICHAEL WOODARD PT, DPT
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
1225100000XPhysical Therapist301372CA

General Provider Information

NPI Number : 1083371314
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL WOODARD PT, DPT
Provider Business Mailing Address
First Line : 4178 32ND ST APT 8
Second Line :
City : SAN DIEGO
State : CA
Zip : 92104-2067
Country : US
Telephone Number : 805-757-3744
Fax Number :
Provider Business Practice Location Address
First Line : 585 SATURN BLVD STE A
Second Line :
City : SAN DIEGO
State : CA
Zip : 92154-4721
Country : US
Telephone Number : 619-591-1190
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2021
Last Update Date : 11/22/2021

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Directions to “ MICHAEL WOODARD PT, DPT” Practice Location

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