Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 12702PT | AZ |
NPI | 1043753494 |
---|---|
Provider Name | Cassandra Woodland |
First Address | Gold Canyon, AZ 85118-1819 |
Second Address | Tempe, AZ 85282-7518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2016 |
Last Update Date | 02/12/2016 |