Provider Demographics
NPI:1679865307
Name:WARD, KEVIN C (DPT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:WARD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 SUTTON ST STE 1C
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-1620
Mailing Address - Country:US
Mailing Address - Phone:978-685-8059
Mailing Address - Fax:978-685-6421
Practice Address - Street 1:231 SUTTON ST STE 1C
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-1620
Practice Address - Country:US
Practice Address - Phone:978-685-8059
Practice Address - Fax:978-685-6421
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19223225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist