Individual
RUSTY M WOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
704 MCKINLEY AVENUE, KELLOGG, ID 83837
(208) 783-3015
Mailing address
P.O. BOX 546, PINEHURST, ID 83850
(208) 682-3082
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1460
ID
Other
Enumeration date
03/24/2011
Last updated
03/24/2011
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