Provider Demographics
NPI:1679736433
Name:HEALER-WARD, MADELYN CAROL (PTA)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:CAROL
Last Name:HEALER-WARD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CATHEDRAL DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-6305
Mailing Address - Country:US
Mailing Address - Phone:307-856-6166
Mailing Address - Fax:
Practice Address - Street 1:1002 FOREST DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2918
Practice Address - Country:US
Practice Address - Phone:307-856-1511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY142225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant