MEDICARE: REBECCA WARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT005304	GA

General Provider Information

NPI Number	:	1710330162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA WARD

Provider Business Mailing Address
First Line	:	176 ATLANTA ST
Second Line	:	SUITE B
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-2110
Country	:	US
Telephone Number	:	678-683-1901
Fax Number	:

Provider Business Practice Location Address
First Line	:	176 ATLANTA ST
Second Line	:	SUITE B
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-2110
Country	:	US
Telephone Number	:	678-683-1901
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2016
Last Update Date	:	07/21/2016

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Directions to “ REBECCA WARD ” Practice Location

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