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General NPI Number Information
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NPI Number | 1639108236
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Entity Type | Individual
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Provider Name | KENNETH A WOODARD JR. MS,LAT,ATC,PES,CES
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 211 REDBIRD LN
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City | BEAUMONT
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State | TX
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Zip | 77705-9801
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Country | US
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Telephone | 409-880-7394
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Fax | 409-880-2366
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Provider Business Mailing Address
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Address Line | 211 REDBIRD LN CAMPUS BOX 10611/ATHLETIC TRAINING
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City | BEAUMONT
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State | TX
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Zip | 77705-9801
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Country | US
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Telephone | 409-880-7394
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Fax | 409-880-2366
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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 | AT6526
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License Number State | TX
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