Basic Information
| Provider Information | |||||||||
| NPI: | 1669431961 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WARD | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2413 PROFESSIONAL DR | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278042254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524430808 | ||||||||
| FaxNumber: | 2524519032 | ||||||||
| Practice Location | |||||||||
| Address1: | 1004 PROCURE DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | FUQUAY VARINA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275262620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195573017 | ||||||||
| FaxNumber: | 9195573748 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 12/04/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 7944 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | P00439813 | 01 | NC | MEDICARE RAILROAD | OTHER | 7211479 | 05 | NC | MEDICAID | 7590420 | 01 | AETNA | OTHER | 078RV | 01 | NC | BLUE CROSS | OTHER | 195865 | 01 | MEDCOST | OTHER |