Healthcare Provider Details

I. General information

NPI: 1477536407
Provider Name (Legal Business Name): JOHN W. WARE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4038 PONTCHARTRAIN DR
SLIDELL LA
70458-5136
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 985-641-2996
  • Fax: 985-643-2307
Mailing address:
  • Phone: 816-226-4011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number07998R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: