MEDICARE: DAN WOODWORTH

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	PT19400	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT19400	OTHER	CA	CALIFORNIA BLUE CROSS
2	ZZZ03532Z	OTHER	CA	BLUE SHILED GROUP NUMBER

General Provider Information

NPI Number	:	1851305486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAN WOODWORTH

Provider Business Mailing Address
First Line	:	2700 E FOOTHILL BLVD
Second Line	:	SUITE 121
City	:	PASADENA
State	:	CA
Zip	:	91107-7100
Country	:	US
Telephone Number	:	626-449-4347
Fax Number	:	626-449-4317

Provider Business Practice Location Address
First Line	:	2700 E FOOTHILL BLVD
Second Line	:	SUITE 121
City	:	PASADENA
State	:	CA
Zip	:	91107-7100
Country	:	US
Telephone Number	:	626-449-4347
Fax Number	:	626-449-4317

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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Directions to “ DAN WOODWORTH ” Practice Location

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