Provider Demographics
NPI:1104896810
Name:WARD, KEVIN M (PT DPT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:WARD
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 412
Mailing Address - Street 2:STEP BY STEP PHYSICAL THERAPY PC
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569
Mailing Address - Country:US
Mailing Address - Phone:585-786-8700
Mailing Address - Fax:585-786-2659
Practice Address - Street 1:2333 N MAIN ST
Practice Address - Street 2:STEP BY STEP PHYSICAL THERAPY PC
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569
Practice Address - Country:US
Practice Address - Phone:585-786-8700
Practice Address - Fax:585-786-2659
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01678880Medicaid
NY13013BMedicare ID - Type Unspecified
S27709Medicare UPIN