Provider Demographics
NPI:1972213858
Name:WOOLDRIDGE, THERESA RENEE
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:RENEE
Last Name:WOOLDRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2888 OLD STATE ROUTE 32
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-3332
Mailing Address - Country:US
Mailing Address - Phone:513-724-8660
Mailing Address - Fax:
Practice Address - Street 1:2888 OLD STATE ROUTE 32
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-3332
Practice Address - Country:US
Practice Address - Phone:513-724-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No172A00000XOther Service ProvidersDriver
No376J00000XNursing Service Related ProvidersHomemaker