Provider Demographics
NPI:1063397818
Name:WOODHEAD, MIKAELA (PT, DPT)
Entity type:Individual
Prefix:
First Name:MIKAELA
Middle Name:
Last Name:WOODHEAD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 PARKRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5721
Mailing Address - Country:US
Mailing Address - Phone:775-527-4822
Mailing Address - Fax:
Practice Address - Street 1:1351 CORPORATE BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-7102
Practice Address - Country:US
Practice Address - Phone:775-825-6450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist