MEDICARE: MR. ROBERT LEWIS WARD PTA

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	225200000X	Physical Therapy Assistant	PTA16963	FL

General Provider Information

NPI Number	:	1609147065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT LEWIS WARD PTA

Provider Business Mailing Address
First Line	:	536 EBBTIDE DR
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-4819
Country	:	US
Telephone Number	:	561-340-9546
Fax Number	:

Provider Business Practice Location Address
First Line	:	536 EBBTIDE DR
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-4819
Country	:	US
Telephone Number	:	561-340-9546
Fax Number	:

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

Provider Enumeration Date	:	01/17/2012
Last Update Date	:	01/17/2012

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