Provider Demographics
NPI:1720761463
Name:WOODS, JUSTICE M (LMT)
Entity type:Individual
Prefix:
First Name:JUSTICE
Middle Name:M
Last Name:WOODS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2826 VIKING DR APT 2A
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5409
Mailing Address - Country:US
Mailing Address - Phone:920-391-1251
Mailing Address - Fax:
Practice Address - Street 1:206 N 8TH ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-4606
Practice Address - Country:US
Practice Address - Phone:920-374-4568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17208-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist