Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 40QB00328200 | NJ |
NPI | 1003320193 |
---|---|
Provider Name | Bobby J Woods |
First Address | Sicklerville, NJ 08081-4212 |
Second Address | Sicklerville, NJ 08081-4212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2017 |
Last Update Date | 28/11/2017 |