MEDICARE: LADARIUS 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	225100000X	Physical Therapist	PTH7305	AL

General Provider Information

NPI Number	:	1285034710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LADARIUS WOODS

Provider Business Mailing Address
First Line	:	PO BOX 1227
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39158-1227
Country	:	US
Telephone Number	:	601-260-4605
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 EASTDALE DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-2158
Country	:	US
Telephone Number	:	601-260-4605
Fax Number	:

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

Provider Enumeration Date	:	09/03/2014
Last Update Date	:	09/03/2014

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Directions to “ LADARIUS WOODS ” Practice Location

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