Provider Demographics
NPI:1316093610
Name:WOODRUFF, NANCY DIANE (PT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:DIANE
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:DIANE
Other - Last Name:TARUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1888 N LARK CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-7412
Mailing Address - Country:US
Mailing Address - Phone:316-722-9008
Mailing Address - Fax:
Practice Address - Street 1:834 N SOCORA ST STE 1
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3279
Practice Address - Country:US
Practice Address - Phone:316-440-3731
Practice Address - Fax:316-440-3741
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-013062251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic