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NPI Code Detail

MEDICARE: WALTER WARD GOLDEN P.T.

MEDICARE: WALTER WARD GOLDEN P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist05000349AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000200731OTHERINBLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number : 1295731115
Entity Type Code : Individual
Provider Name (Legal Business Name) : WALTER WARD GOLDEN P.T.
Provider Business Mailing Address
First Line : 640 INDUSTRIAL PKWY
Second Line :
City : ELKHART
State : IN
Zip : 46516-5414
Country : US
Telephone Number : 574-522-7203
Fax Number : 574-522-7405
Provider Business Practice Location Address
First Line : 640 INDUSTRIAL PKWY
Second Line :
City : ELKHART
State : IN
Zip : 46516-5414
Country : US
Telephone Number : 574-522-7203
Fax Number : 574-522-7405
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2005
Last Update Date : 07/08/2007

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Directions to “ WALTER WARD GOLDEN P.T.” Practice Location

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