Provider Demographics
NPI:1609994045
Name:JOHN WARD PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:JOHN WARD PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PELOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-364-0130
Mailing Address - Street 1:4259 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02813-2571
Mailing Address - Country:US
Mailing Address - Phone:401-364-0130
Mailing Address - Fax:401-364-0130
Practice Address - Street 1:4259 OLD POST RD
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02813-2571
Practice Address - Country:US
Practice Address - Phone:401-364-0130
Practice Address - Fax:401-364-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI709003312OtherPTAN