Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2305209837 | VA |
NPI | 1003164088 |
---|---|
Provider Name | Kelsey T Wood |
First Address | Lynchburg, VA 24502-5165 |
Second Address | Lynchburg, VA 24503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2012 |
Last Update Date | 13/07/2018 |