Healthcare Provider Details

I. General information

NPI: 1356188304
Provider Name (Legal Business Name): RYAN WARD DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 JEFFERSON LN NE STE C
ALBUQUERQUE NM
87109-2151
US

IV. Provider business mailing address

4630 JEFFERSON LN NE STE C
ALBUQUERQUE NM
87109-2151
US

V. Phone/Fax

Practice location:
  • Phone: 505-633-4141
  • Fax:
Mailing address:
  • Phone: 505-633-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2026-0123
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: