Provider Demographics
NPI:1922445832
Name:WOOLDRIDGE, TRAVIS CHARLES (CSA)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:CHARLES
Last Name:WOOLDRIDGE
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-9557
Mailing Address - Country:US
Mailing Address - Phone:270-993-5259
Mailing Address - Fax:
Practice Address - Street 1:520 KELLY RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-9557
Practice Address - Country:US
Practice Address - Phone:270-993-5259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist