Provider Demographics
NPI:1265519722
Name:WARD, AUDREY LEIGH (PT)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:LEIGH
Last Name:WARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SORGHUM HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-6942
Mailing Address - Country:US
Mailing Address - Phone:931-363-3645
Mailing Address - Fax:931-363-5001
Practice Address - Street 1:993 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4432
Practice Address - Country:US
Practice Address - Phone:931-363-3572
Practice Address - Fax:931-363-5001
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist