Provider Demographics
NPI:1366521569
Name:WARD, MARY JANE (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:WARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JANE
Other - Last Name:PAFFENBACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-0179
Mailing Address - Country:US
Mailing Address - Phone:410-838-9600
Mailing Address - Fax:410-838-2511
Practice Address - Street 1:844 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6664
Practice Address - Country:US
Practice Address - Phone:410-876-5600
Practice Address - Fax:410-876-1623
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18264225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD216566Medicare ID - Type Unspecified