Provider Demographics
NPI:1881789782
Name:WOOLDRIDGE, DARLENE S (PT)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:S
Last Name:WOOLDRIDGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 NE 26TH ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1416
Mailing Address - Country:US
Mailing Address - Phone:954-565-0075
Mailing Address - Fax:954-565-0085
Practice Address - Street 1:1881 NE 26TH ST
Practice Address - Street 2:SUITE 10
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1416
Practice Address - Country:US
Practice Address - Phone:954-565-0075
Practice Address - Fax:954-565-0085
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6244Medicare ID - Type UnspecifiedGROUP
FLU3285ZMedicare ID - Type UnspecifiedINDIVIDUAL