Provider Demographics
NPI:1184190126
Name:WARD, WINSTON WADE II (LMT)
Entity Type:Individual
Prefix:MR
First Name:WINSTON
Middle Name:WADE
Last Name:WARD
Suffix:II
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6770 US HIGHWAY 27 N
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-0600
Mailing Address - Country:US
Mailing Address - Phone:239-823-6673
Mailing Address - Fax:863-382-0831
Practice Address - Street 1:6770 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870
Practice Address - Country:US
Practice Address - Phone:239-823-6673
Practice Address - Fax:863-382-0831
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA88990225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist