Provider Demographics
NPI:1013790468
Name:WARD, JEFFREY S (ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:WARD
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 DALE CT
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2133
Mailing Address - Country:US
Mailing Address - Phone:707-592-4265
Mailing Address - Fax:
Practice Address - Street 1:200 MARITIME ACADEMY DR DEPT OF
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-8181
Practice Address - Country:US
Practice Address - Phone:707-654-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer