Provider Demographics
NPI:1891513776
Name:WOODWARD, WILLIAM ROBERT FORREST (DPT, PT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROBERT FORREST
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:WILL
Other - Middle Name:ROBERT FORREST
Other - Last Name:WOODWARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT, PT
Mailing Address - Street 1:361 PERALTA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-2217
Mailing Address - Country:US
Mailing Address - Phone:562-343-6782
Mailing Address - Fax:
Practice Address - Street 1:6695 E PACIFIC COAST HWY STE 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4256
Practice Address - Country:US
Practice Address - Phone:562-596-7074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist