Provider Demographics
NPI:1134901903
Name:WOODARD, CHANTEL (PTA)
Entity type:Individual
Prefix:
First Name:CHANTEL
Middle Name:
Last Name:WOODARD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13418 TITAN
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-2842
Mailing Address - Country:US
Mailing Address - Phone:210-846-1496
Mailing Address - Fax:
Practice Address - Street 1:10790 TOEPPERWEIN RD
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-2569
Practice Address - Country:US
Practice Address - Phone:210-846-1496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2172898225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant