MEDICARE: SUSAN LUPIDI WOOD PT, DPT, CERT. MDT

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	2251X0800X	Orthopedic Physical Therapist	12136	TN

General Provider Information

NPI Number	:	1861959215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN LUPIDI WOOD PT, DPT, CERT. MDT

Provider Business Mailing Address
First Line	:	604 BLOOMFIELD WAY
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-4766
Country	:	US
Telephone Number	:	859-333-4181
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 PROVIDENCE TRL STE 102
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-6386
Country	:	US
Telephone Number	:	615-553-9761
Fax Number	:

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

Provider Enumeration Date	:	02/21/2019
Last Update Date	:	02/21/2019

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