MEDICARE: COLLEEN WARD PT

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
1	225100000X	Physical Therapist	1299056	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1299056	OTHER	TX	TEXAS PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1356854731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN WARD PT

Provider Business Mailing Address
First Line	:	800 W HIGHWAY 290 STE B300
Second Line	:
City	:	DRIPPING SPRINGS
State	:	TX
Zip	:	78620-4051
Country	:	US
Telephone Number	:	512-858-5191
Fax Number	:	512-858-5194

Provider Business Practice Location Address
First Line	:	800 W HIGHWAY 290 STE B300
Second Line	:
City	:	DRIPPING SPRINGS
State	:	TX
Zip	:	78620-4051
Country	:	US
Telephone Number	:	512-858-5191
Fax Number	:	512-858-5194

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2017
Last Update Date	:	11/08/2017

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Directions to “ COLLEEN WARD PT” Practice Location

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