Provider Demographics
NPI:1861701096
Name:WOODYARD, CAITLIN (PT)
Entity type:Individual
Prefix:MS
First Name:CAITLIN
Middle Name:
Last Name:WOODYARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5571
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-0571
Mailing Address - Country:US
Mailing Address - Phone:541-505-8180
Mailing Address - Fax:
Practice Address - Street 1:1180 PATTERSON ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3619
Practice Address - Country:US
Practice Address - Phone:541-505-8180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3346225100000X
VT040-0003798225100000X
OR6820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist