Active NPI
Douglas Erick Wood, PTA
- Physical Therapy Assistant
- Southport, NC
National Provider Identifier
1902106065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2801
- Practice address
- 630 N Fodale Ave
Southport, NC 28461-3538 - Phone
- (910) 457-9581
- NPI assigned
- Oct 23, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2801 | NC | Primary |
Addresses
Primary practice location
630 N Fodale Ave
Southport, NC 28461-3538
Mailing address
630 N Fodale Ave
Southport, NC 28461-3538
Phone (910) 457-9581
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2801 | NC | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287792000000",
"number": "1902106065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 N FODALE AVE",
"city": "SOUTHPORT",
"state": "NC",
"postal_code": "284613538",
"telephone_number": "910-457-9581"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 N FODALE AVE",
"city": "SOUTHPORT",
"state": "NC",
"postal_code": "284613538",
"telephone_number": "910-457-9581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOOD",
"first_name": "DOUGLAS",
"middle_name": "ERICK",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-10-23",
"last_updated": "2010-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NC",
"license": "2801",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southport, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.