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NPI Code Detail

MEDICARE: TRACY MARIE WOODSON MSPT, DPT

MEDICARE: TRACY MARIE WOODSON MSPT, 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
1208100000XPhysical Medicine & Rehabilitation Physician3643OR

Other Identifiers

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

General Provider Information

NPI Number : 1922112051
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY MARIE WOODSON MSPT, DPT
Provider Business Mailing Address
First Line : PO BOX 3158
Second Line :
City : PORTLAND
State : OR
Zip : 97208-3158
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1627 WOODS CT
Second Line :
City : HOOD RIVER
State : OR
Zip : 97031-2915
Country : US
Telephone Number : 541-386-9511
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2006
Last Update Date : 10/26/2015

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