Provider Demographics
NPI:1487027561
Name:WARD, JOHN GARRETT (MS, ATC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:GARRETT
Last Name:WARD
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 IDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-6429
Mailing Address - Country:US
Mailing Address - Phone:716-694-7120
Mailing Address - Fax:
Practice Address - Street 1:20 ALUMNI ARENA
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14260-3085
Practice Address - Country:US
Practice Address - Phone:716-645-8794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0011392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer