Provider Demographics
NPI:1376045161
Name:WARD, STEVEN ERIC (PTA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ERIC
Last Name:WARD
Suffix:
Gender:M
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:PO BOX 1183
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30722-1183
Mailing Address - Country:US
Mailing Address - Phone:706-483-4009
Mailing Address - Fax:
Practice Address - Street 1:1300 CLEO WAY
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8442
Practice Address - Country:US
Practice Address - Phone:706-226-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000404225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant