Basic Information
| Provider Information | |||||||||
| NPI: | 1114078128 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | SMITH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | D.P.T., C.S.C.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 720 | ||||||||
| Address2: | 210 S. MAIN ST. | ||||||||
| City: | AMHERST | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245210720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349461314 | ||||||||
| FaxNumber: | 4349461083 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 S. MAIN ST. | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245210720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349461314 | ||||||||
| FaxNumber: | 4349461083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305203874 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.