Provider Demographics
NPI:1659840502
Name:WARD, ANTHONY CARL (CPO)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:CARL
Last Name:WARD
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MEDICAL VILLAGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5403
Mailing Address - Country:US
Mailing Address - Phone:859-341-7688
Mailing Address - Fax:859-341-4476
Practice Address - Street 1:20 MEDICAL VILLAGE DR STE 100
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-5403
Practice Address - Country:US
Practice Address - Phone:859-341-7688
Practice Address - Fax:859-341-4476
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPO-109222Z00000X, 224P00000X
OHLPO.00217222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist