Individual
MR. IAN A WOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1 DENT DR, LEWISBURG, PA 17837-2005
(570) 577-1056
Mailing address
1 DENT DR, LEWISBURG, PA 17837-2005
(570) 577-1056
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
000153-1
NY
2255A2300X
Athletic Trainer
36000152A
IN
2255A2300X
Athletic Trainer
767
CO
2255A2300X
Athletic Trainer
96-039
WI
2255A2300X
Athletic Trainer
Primary
RT001549A
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
069402484
BOARD OF CERTIFICATION FOR ATHLETIC TRAINING
—
01
—
RT001549A
STATE ATHLETIC TRAINING LICENSE
PA
Enumeration date
07/03/2006
Last updated
08/13/2017
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