Provider Demographics
NPI:1851126619
Name:WOOD, BAILEY MATTHEW (LMT)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:MATTHEW
Last Name:WOOD
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5319 SUMMERLIN RD APT 10
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-7639
Mailing Address - Country:US
Mailing Address - Phone:704-307-5096
Mailing Address - Fax:
Practice Address - Street 1:5319 SUMMERLIN RD APT 10
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-7639
Practice Address - Country:US
Practice Address - Phone:704-307-5096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18667225700000X
FL103469225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist