MEDICARE: JAMES WARD JR. RPT

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	225100000X	Physical Therapist	PT12789	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982787842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES WARD JR. RPT

Provider Business Mailing Address
First Line	:	11081 CLAIREMONT MESA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-1506
Country	:	US
Telephone Number	:	858-431-9303
Fax Number	:	858-737-4009

Provider Business Practice Location Address
First Line	:	11081 CLAIREMONT MESA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-1506
Country	:	US
Telephone Number	:	858-431-9303
Fax Number	:	858-737-4009

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	01/12/2017

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