Provider Demographics
NPI:1154096121
Name:WARD, HANNAH (PTA)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S STONE ST
Mailing Address - Street 2:
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-7605
Mailing Address - Country:US
Mailing Address - Phone:386-264-1416
Mailing Address - Fax:
Practice Address - Street 1:6061 SAINT JOHNS AVE STE 1
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-6858
Practice Address - Country:US
Practice Address - Phone:386-312-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA31376225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant