MEDICARE: JESSICA WOOD PT, DPT, ATP

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	2305209494	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750963351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA WOOD PT, DPT, ATP

Provider Business Mailing Address
First Line	:	1276 CONCORD AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-6518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1276 CONCORD AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-6518
Country	:	US
Telephone Number	:	804-351-5824
Fax Number	:

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

Provider Enumeration Date	:	04/22/2021
Last Update Date	:	04/22/2021

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