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General NPI Number Information
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NPI Number | 1558013201
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Entity Type | Individual
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Provider Name | JOSHUA D WOOLDRIDGE LAT, ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 01/15/2024
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Provider Practice Location Address
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Address Line | 4505 S MARYLAND PKWY
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City | LAS VEGAS
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State | NV
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Zip | 89154-9900
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Country | US
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Telephone | 585-201-6220
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Fax |
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Provider Business Mailing Address
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Address Line | NDSU DEPT 2684 PO BOX 6050
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City | FARGO
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State | ND
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Zip | 58108-6050
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Country | US
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Telephone | 701-231-1796
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0506567
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 975-23
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License Number State | ND
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