Provider Demographics
NPI:1346930708
Name:WARD, ELLEN INEZ (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:INEZ
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 1:2500 OLD STAGE RD
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-8563
Mailing Address - Country:US
Mailing Address - Phone:406-660-2014
Mailing Address - Fax:
Practice Address - Street 1:200 N OREGON ST # 3624
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3624
Practice Address - Country:US
Practice Address - Phone:406-683-5105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PTA-LIC-21696225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant