Provider Demographics
NPI:1396514642
Name:WARD, LANDON CLARK (DPT, PT)
Entity type:Individual
Prefix:
First Name:LANDON
Middle Name:CLARK
Last Name:WARD
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 601791
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1791
Mailing Address - Country:US
Mailing Address - Phone:336-893-2460
Mailing Address - Fax:336-893-2468
Practice Address - Street 1:7210 VILLAGE MEDICAL CIR STE 115
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8045
Practice Address - Country:US
Practice Address - Phone:336-893-2460
Practice Address - Fax:336-893-2468
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCP228272251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic