Provider Demographics
NPI:1760461594
Name:WARD, MOLLY ANN (PTA)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANN
Last Name:WARD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 MARTINSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BLANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45107-9737
Mailing Address - Country:US
Mailing Address - Phone:513-659-4937
Mailing Address - Fax:
Practice Address - Street 1:9419 KENWOOD RD
Practice Address - Street 2:SUITE 301
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-6811
Practice Address - Country:US
Practice Address - Phone:513-792-0777
Practice Address - Fax:513-792-0061
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA-3663225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant