MEDICARE: LOUISE J WOOD 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
1	174400000X	Specialist	298	AK
2	225100000X	Physical Therapist	298	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	92-0135259	OTHER	AK	TAX ID#

General Provider Information

NPI Number	:	1689750176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUISE J WOOD DPT

Provider Business Mailing Address
First Line	:	1045 E KLATT RD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-3541
Country	:	US
Telephone Number	:	907-245-1245
Fax Number	:	907-245-1244

Provider Business Practice Location Address
First Line	:	1045 E KLATT RD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-3541
Country	:	US
Telephone Number	:	907-245-1245
Fax Number	:	907-245-1244

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	08/09/2021

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