Healthcare Provider Details

I. General information

NPI: 1568231611
Provider Name (Legal Business Name): LANCE WARD DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2023
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 OLD WINSTON RD
KERNERSVILLE NC
27284-7140
US

IV. Provider business mailing address

3621 N ELM ST APT 2D
GREENSBORO NC
27455-2860
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberP22826
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberP22826
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: