Provider Demographics
NPI:1487904322
Name:WOOD, THERESA MARIE (PTA)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:MARIE
Last Name:WOOD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 BREWER RD
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848
Mailing Address - Country:US
Mailing Address - Phone:989-277-9272
Mailing Address - Fax:
Practice Address - Street 1:5230 BREWER RD
Practice Address - Street 2:
Practice Address - City:LAINGSBURG
Practice Address - State:MI
Practice Address - Zip Code:48848-8765
Practice Address - Country:US
Practice Address - Phone:989-277-9272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502000981225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant