MEDICARE: GLENN WOOD MD PA

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	558670000	TX
2	235Z00000X	Speech-Language Pathologist
3	208000000X	Pediatrics Physician	K4012	TX

General Provider Information

NPI Number	:	1457652703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENN WOOD MD PA

Provider Business Mailing Address
First Line	:	9411 N LAMAR BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78753-4178
Country	:	US
Telephone Number	:	512-977-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2621 RIDGEPOINT DR
Second Line	:	SUITE 130
City	:	AUSTIN
State	:	TX
Zip	:	78754-5232
Country	:	US
Telephone Number	:	512-583-9600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GLENN WOOD
Credential	:	MD
Telephone Number	:	512-583-9600

Provider Enumeration Date	:	11/03/2010
Last Update Date	:	11/03/2010

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Directions to “GLENN WOOD MD PA ” Practice Location

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