Provider Demographics
NPI:1831538420
Name:WOOLDRIDGE, LOREN TYLER (DPT)
Entity type:Individual
Prefix:
First Name:LOREN
Middle Name:TYLER
Last Name:WOOLDRIDGE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 COCHISE ST # 80
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-6367
Mailing Address - Country:US
Mailing Address - Phone:775-525-8681
Mailing Address - Fax:775-525-8681
Practice Address - Street 1:4250 COCHISE ST # 80
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-6367
Practice Address - Country:US
Practice Address - Phone:775-525-8681
Practice Address - Fax:775-525-8681
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NV32252251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist