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General NPI Number Information
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NPI Number | 1104644095
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Entity Type | Individual
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Provider Name | BOBBY EARL WARD II MASSAGE THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 1315 S GLENBURNIE RD STE D17
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City | NEW BERN
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State | NC
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Zip | 28562-2614
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Country | US
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Telephone | 252-671-6237
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Fax |
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Provider Business Mailing Address
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Address Line | 118 HAGAR LN
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City | POLLOCKSVILLE
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State | NC
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Zip | 28573-3200
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Country | US
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Telephone | 252-671-6237
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 11121
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License Number State | NC
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