Provider Demographics
NPI:1669431961
Name:WARD, BRIAN CHRISTOPHER (MPT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:CHRISTOPHER
Last Name:WARD
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2254
Mailing Address - Country:US
Mailing Address - Phone:252-443-0808
Mailing Address - Fax:252-451-9032
Practice Address - Street 1:1004 PROCURE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2620
Practice Address - Country:US
Practice Address - Phone:919-557-3017
Practice Address - Fax:919-557-3748
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00439813OtherMEDICARE RAILROAD
NC7211479Medicaid
7590420OtherAETNA
NC078RVOtherBLUE CROSS
195865OtherMEDCOST
2509255AMedicare PIN
NCP00439813OtherMEDICARE RAILROAD
195865OtherMEDCOST