Provider Demographics
NPI:1982787842
Name:WARD, JAMES JR (RPT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:WARD
Suffix:JR
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11081 CLAIREMONT MESA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-1506
Mailing Address - Country:US
Mailing Address - Phone:858-431-9303
Mailing Address - Fax:858-737-4009
Practice Address - Street 1:11081 CLAIREMONT MESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-1506
Practice Address - Country:US
Practice Address - Phone:858-431-9303
Practice Address - Fax:858-737-4009
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12789225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0127890Medicaid
CAPT12789Medicare ID - Type Unspecified
CAPT0127890Medicaid