Provider Demographics
NPI:1336682582
Name:WARD, BETH P (ATC)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:P
Last Name:WARD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 SOUTH ST
Mailing Address - Street 2:APT 2R
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1542
Mailing Address - Country:US
Mailing Address - Phone:630-715-5580
Mailing Address - Fax:
Practice Address - Street 1:1622 SOUTH ST
Practice Address - Street 2:APT 2R
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1542
Practice Address - Country:US
Practice Address - Phone:630-715-5580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0061092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer