Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1692 | MT |
NPI | 1003023144 |
---|---|
Provider Name | Mrs. Wendi Jo Wood |
First Address | Florence, MT 59833-6636 |
Second Address | Stevensville, MT 59870-2603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 08/07/2007 |