Provider Demographics
NPI:1982956082
Name:WOODARD, TERRY WAYNE (RCP)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:WAYNE
Last Name:WOODARD
Suffix:
Gender:M
Credentials:RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:34740 BOROS BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-7467
Mailing Address - Country:US
Mailing Address - Phone:323-371-4514
Mailing Address - Fax:951-755-7277
Practice Address - Street 1:34740 BOROS BLVD.
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223
Practice Address - Country:US
Practice Address - Phone:323-371-4514
Practice Address - Fax:951-755-7277
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8622278G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care