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NPI Code Detail

MEDICARE: MR. IAN A WOOD ATC

MEDICARE: MR. IAN A WOOD ATC
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
12255A2300XAthletic Trainer767CO
22255A2300XAthletic Trainer96-039WI
32255A2300XAthletic Trainer36000152AIN
42255A2300XAthletic Trainer000153-1NY
52255A2300XAthletic TrainerRT001549APA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1069402484OTHERBOARD OF CERTIFICATION FOR ATHLETIC TRAINING
2RT001549AOTHERPASTATE ATHLETIC TRAINING LICENSE

General Provider Information

NPI Number : 1811927254
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. IAN A WOOD ATC
Provider Business Mailing Address
First Line : 1 DENT DR
Second Line :
City : LEWISBURG
State : PA
Zip : 17837-2005
Country : US
Telephone Number : 570-577-1056
Fax Number :
Provider Business Practice Location Address
First Line : 1 DENT DR
Second Line :
City : LEWISBURG
State : PA
Zip : 17837-2005
Country : US
Telephone Number : 570-577-1056
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2006
Last Update Date : 08/13/2017

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