Provider Demographics
NPI:1114374741
Name:WARD, REAGAN RONALD (DPT)
Entity Type:Individual
Prefix:
First Name:REAGAN
Middle Name:RONALD
Last Name:WARD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 FALLS AVE E STE 401
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3455
Mailing Address - Country:US
Mailing Address - Phone:208-969-9945
Mailing Address - Fax:208-944-0488
Practice Address - Street 1:931 CENTER ST W STE C
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:ID
Practice Address - Zip Code:83341-5326
Practice Address - Country:US
Practice Address - Phone:208-423-9999
Practice Address - Fax:208-423-9998
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7832781-2401225100000X
ID4532225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist