Individual
BLAINE WOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4325 ATLANTA HWY, SUITE 15, LOGANVILLE, GA 30052-2341
(770) 466-3100
(770) 466-3105
Mailing address
448 MAPLE COURT RIDGE, LOGANVILLE, GA 30052
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT003406
GA
Other
Enumeration date
06/19/2006
Last updated
07/08/2007
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