Provider Demographics
NPI:1902861990
Name:WARD, ADRIENNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ADRIENNE
Other - Middle Name:
Other - Last Name:GORHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:11 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-4601
Mailing Address - Country:US
Mailing Address - Phone:518-843-3805
Mailing Address - Fax:518-843-6184
Practice Address - Street 1:11 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-4601
Practice Address - Country:US
Practice Address - Phone:518-843-3805
Practice Address - Fax:518-843-6184
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000499689002OtherBLUE SHIELD
NY10060791OtherCDPHP
NY2959892OtherAETNA HMO
NYQ19481OtherEMPIRE
NY380209OtherMVP
NY0007211390OtherAETNA PPO
NYRA7827Medicare ID - Type UnspecifiedMEDICARE