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General NPI Number Information
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NPI Number | 1609669647
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Entity Type | Individual
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Provider Name | LISA WARD LICENSED PTA
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Gender | Female
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 14700 LAKE SHORE DR
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City | CHARLEVOIX
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State | MI
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Zip | 49720-1999
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Country | US
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Telephone | 231-547-8630
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Fax |
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Provider Business Mailing Address
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Address Line | 105 BENNETT ST
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City | EAST JORDAN
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State | MI
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Zip | 49727-8689
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Country | US
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Telephone | 231-564-0753
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Fax | 231-564-0753
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502004889
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License Number State | MI
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