Healthcare Provider Details

I. General information

NPI: 1366521569
Provider Name (Legal Business Name): MARY JANE WARD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY JANE PAFFENBACK PT

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 WASHINGTON RD
WESTMINSTER MD
21157-6664
US

IV. Provider business mailing address

PO BOX 179
FOREST HILL MD
21050-0179
US

V. Phone/Fax

Practice location:
  • Phone: 410-876-5600
  • Fax: 410-876-1623
Mailing address:
  • Phone: 410-838-9600
  • Fax: 410-838-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18264
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: