Provider Demographics
NPI:1992281729
Name:WOOD, NATHANIAL (ATC)
Entity type:Individual
Prefix:
First Name:NATHANIAL
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28927 STORMCLOUD PASS
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-6429
Mailing Address - Country:US
Mailing Address - Phone:603-944-5907
Mailing Address - Fax:
Practice Address - Street 1:13330 USF LAUREL DR FL 3
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-6601
Practice Address - Country:US
Practice Address - Phone:813-974-6274
Practice Address - Fax:813-974-9494
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL25192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
030802071OtherNATA BOC
FLAL2519OtherFLORIDA DEPARTMENT OF HEALTH