Provider Demographics
NPI:1598004079
Name:WARD, ELEANOR NANNETTE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:NANNETTE
Last Name:WARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:NANNETTE
Other - Middle Name:H
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:8411 BRYANT RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-0309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8411 BRYANT RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-0309
Practice Address - Country:US
Practice Address - Phone:863-670-7896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3472225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist