Provider Demographics
NPI:1558362293
Name:WARD, JOHN E (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:E
Last Name:WARD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4259 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02813-2501
Mailing Address - Country:US
Mailing Address - Phone:401-364-0100
Mailing Address - Fax:401-364-0130
Practice Address - Street 1:4649A OLD POST RD
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02813-2519
Practice Address - Country:US
Practice Address - Phone:401-364-0100
Practice Address - Fax:401-364-0130
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00586225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
002056173Medicare ID - Type Unspecified
709003312Medicare ID - Type Unspecified