MEDICARE: JENNIFER WOODRUFF PT, 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
1	225100000X	Physical Therapist	32168	CA

General Provider Information

NPI Number	:	1982967188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER WOODRUFF PT, DPT

Provider Business Mailing Address
First Line	:	553 45TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609-2025
Country	:	US
Telephone Number	:	917-714-5414
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 GRAND AVE
Second Line	:	SUITE 300
City	:	OAKLAND
State	:	CA
Zip	:	94612-3741
Country	:	US
Telephone Number	:	917-714-5414
Fax Number	:

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

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	12/28/2021

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