Provider Demographics
NPI:1316532369
Name:WOODWARD, DYLAN BRADFORD (DPT)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:BRADFORD
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5704 E LAKE SAMMAMISH PKWY SE STE 101
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-8941
Mailing Address - Country:US
Mailing Address - Phone:425-270-3323
Mailing Address - Fax:425-270-3326
Practice Address - Street 1:5704 E LAKE SAMMAMISH PKWY SE STE 101
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-8941
Practice Address - Country:US
Practice Address - Phone:425-270-3323
Practice Address - Fax:425-270-3326
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61136132225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist