Provider Demographics
NPI:1750607560
Name:WARD, LAURA P
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:P
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:J
Other - Last Name:PILKERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 SAINT PATRICKS DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4527
Mailing Address - Country:US
Mailing Address - Phone:301-870-7366
Mailing Address - Fax:301-870-6717
Practice Address - Street 1:22715 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650
Practice Address - Country:US
Practice Address - Phone:301-997-0172
Practice Address - Fax:301-997-0175
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist