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Individual

SCOTT WOODBURY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PTA

Contact information

Practice address
1700 E STONE ST, BRENHAM, TX 77833-5150
(979) 830-1996
Mailing address
101 E AIRLINE DR APT 56, BRENHAM, TX 77833-5551

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2115320
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2115320
PTA LICENSE
TX
Enumeration date
01/23/2019
Last updated
01/23/2019
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