Basic Information
| Provider Information | |||||||||
| NPI: | 1619030442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODS | ||||||||
| FirstName: | AMY | ||||||||
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| Credential: | LMP., DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5050 SW LANDING DR | ||||||||
| Address2: | 301 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972395968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063840452 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3303 SW BOND AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972394501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034943151 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 10/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MA00009970 | WA | N | Other Service Providers | Specialist | 225700000X | 20447 | OR | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | 225100000X | 60753 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 60459440 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.