Provider Demographics
NPI:1710861034
Name:WARD, JANELLE S (LMT)
Entity type:Individual
Prefix:MS
First Name:JANELLE
Middle Name:S
Last Name:WARD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 COUNTY ROAD 56
Mailing Address - Street 2:
Mailing Address - City:OHKAY OWINGEH
Mailing Address - State:NM
Mailing Address - Zip Code:87566-8000
Mailing Address - Country:US
Mailing Address - Phone:307-287-0788
Mailing Address - Fax:
Practice Address - Street 1:153 COUNTY ROAD 56
Practice Address - Street 2:
Practice Address - City:OHKAY OWINGEH
Practice Address - State:NM
Practice Address - Zip Code:87566-8000
Practice Address - Country:US
Practice Address - Phone:307-287-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMT8717225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist