Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2305212908 | VA |
N | 2251S0007X | Physical Therapist - Sports | 2305212908 | VA |
NPI | 1508426164 |
---|---|
Provider Name | Matthew Tyler Ward |
First Address | North Chesterfield, VA 23225-4067 |
Second Address | Richmond, VA 23226-1935 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2019 |
Last Update Date | 17/09/2020 |