Provider Demographics
NPI:1073245023
Name:WARD, CALVIN DUCANE (LMT, MT, PT)
Entity Type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:DUCANE
Last Name:WARD
Suffix:
Gender:M
Credentials:LMT, MT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7804 PAN AMERICAN EAST FWY NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4643
Mailing Address - Country:US
Mailing Address - Phone:505-305-5615
Mailing Address - Fax:
Practice Address - Street 1:12 UNSER BLVD SE STE J
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-6300
Practice Address - Country:US
Practice Address - Phone:505-305-5615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMT9662225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMMT9662OtherNEW MEXICO LICENSING BOARD