Provider Demographics
NPI:1194766725
Name:HOWARD, RALPH LEON JR (PT PHD)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:LEON
Last Name:HOWARD
Suffix:JR
Gender:M
Credentials:PT PHD
Other - Prefix:MR
Other - First Name:LEE
Other - Middle Name:
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD PT
Mailing Address - Street 1:905 OLD WINSTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-6640
Mailing Address - Country:US
Mailing Address - Phone:336-287-5526
Mailing Address - Fax:336-993-9943
Practice Address - Street 1:905 OLD WINSTON RD STE B
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-6640
Practice Address - Country:US
Practice Address - Phone:336-287-5526
Practice Address - Fax:336-993-9943
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6408225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5884600001Medicare NSC
NC2509053Medicare PIN