Provider Demographics
NPI:1730270356
Name:WOODALL, JOSHUA ABBOTT (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:ABBOTT
Last Name:WOODALL
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 FRONT ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4003
Mailing Address - Country:US
Mailing Address - Phone:682-651-9028
Mailing Address - Fax:
Practice Address - Street 1:3310 OAK RIDGE DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3418
Practice Address - Country:US
Practice Address - Phone:979-209-7992
Practice Address - Fax:979-209-7972
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT26312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer