Provider Demographics
NPI:1750989018
Name:WARD, EDITH P (DPT)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:P
Last Name:WARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:EDITH
Other - Middle Name:P
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 GRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-3626
Mailing Address - Country:US
Mailing Address - Phone:269-769-6108
Mailing Address - Fax:269-934-5054
Practice Address - Street 1:501 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-3626
Practice Address - Country:US
Practice Address - Phone:269-769-6108
Practice Address - Fax:269-934-5054
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13224225100000X
MI5501020264225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist