# LYNN H WOODLAND

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1679628457
- **Gender:** Man
- **Credential:** M.S. P.T.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | PT-292 | ID | Yes |

## Other

- **Enumeration date:** 01/24/2007
- **Last updated:** 08/04/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000010025913 | BLUE SHIELD OF IDAHO ID\# | ID |
| 05 | — | 004407700 | — | ID |
| 01 | — | 82-0510764 | TAX ID\# | ID |
| 01 | — | T-143-5 | BLUE CROSS OF IDAHO ID\# | ID |