Provider Demographics
NPI:1104925049
Name:WOODWARD, PAUL BRIAN (PT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:BRIAN
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 W GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-1859
Mailing Address - Country:US
Mailing Address - Phone:508-947-5195
Mailing Address - Fax:508-947-3447
Practice Address - Street 1:31 W GROVE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1859
Practice Address - Country:US
Practice Address - Phone:508-947-5195
Practice Address - Fax:508-947-3447
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3005225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0308374Medicaid
MAY68149Medicare UPIN
MA0308374Medicaid