Healthcare Provider Details

I. General information

NPI: 1437054046
Provider Name (Legal Business Name): GREGORY WARD PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2026
Last Update Date: 10/13/2026
Certification Date: 10/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 E 7TH ST STE 2
MOUNTAIN HOME AR
72653-4671
US

IV. Provider business mailing address

308 E 7TH ST STE 2
MOUNTAIN HOME AR
72653-4671
US

V. Phone/Fax

Practice location:
  • Phone: 870-701-1821
  • Fax: 870-701-0110
Mailing address:
  • Phone: 870-701-1821
  • Fax: 870-701-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4971
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: