Provider Demographics
NPI:1104644095
Name:WARD, BOBBY EARL II (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:EARL
Last Name:WARD
Suffix:II
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 HAGAR LN
Mailing Address - Street 2:
Mailing Address - City:POLLOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28573-3200
Mailing Address - Country:US
Mailing Address - Phone:252-671-6237
Mailing Address - Fax:
Practice Address - Street 1:1315 S GLENBURNIE RD STE D17
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2614
Practice Address - Country:US
Practice Address - Phone:252-671-6237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
NC11121225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist