Provider Demographics
NPI:1578672176
Name:WARD, MONTY L (PT)
Entity Type:Individual
Prefix:
First Name:MONTY
Middle Name:L
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 1:24 TRAIL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-9314
Mailing Address - Country:US
Mailing Address - Phone:918-770-1798
Mailing Address - Fax:
Practice Address - Street 1:500 E 141ST ST
Practice Address - Street 2:
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033-3524
Practice Address - Country:US
Practice Address - Phone:918-322-3884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200132790AMedicaid
OK3848OtherLICENSE #
OK200132790AMedicaid