=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093121824
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WARD THERAPIES, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2014
-----------------------------------------------------
Last Update Date | 07/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1302 DEACON DR
-----------------------------------------------------
City | COLLEGE STATION
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77845-6405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-739-3940
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1302 DEACON DR
-----------------------------------------------------
City | COLLEGE STATION
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77845-6405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-739-3940
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MICHAEL TIMOTHY WARD
-----------------------------------------------------
Credential | P.T.
-----------------------------------------------------
Telephone | 979-739-3940
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 1130268
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------