1821764416 NPI number — KAITLIN MARIE WOODS DPT

Table of content: KAITLIN MARIE WOODS DPT (NPI 1821764416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821764416 NPI number — KAITLIN MARIE WOODS DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODS
Provider First Name:
KAITLIN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOGUE, MCCARTHY, SULLIVAN
Provider Other First Name:
KAITLIN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821764416
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4140 FERNCREEK DR STE 801
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28314-2572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-710-5051
Provider Business Mailing Address Fax Number:
910-223-6233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4140 FERNCREEK DR STE 801
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28314-2572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-710-5051
Provider Business Practice Location Address Fax Number:
910-223-6233
Provider Enumeration Date:
08/23/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  P20748 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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