Provider Demographics
NPI:1639108236
Name:WOODARD, KENNETH A JR (MS,LAT,ATC,PES,CES)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:A
Last Name:WOODARD
Suffix:JR
Gender:M
Credentials:MS,LAT,ATC,PES,CES
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Mailing Address - Street 1:211 REDBIRD LN
Mailing Address - Street 2:CAMPUS BOX 10611/ATHLETIC TRAINING
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77705-9801
Mailing Address - Country:US
Mailing Address - Phone:409-880-7394
Mailing Address - Fax:409-880-2366
Practice Address - Street 1:211 REDBIRD LN
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-9801
Practice Address - Country:US
Practice Address - Phone:409-880-7394
Practice Address - Fax:409-880-2366
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAT65262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer