MEDICARE: DR. NICHOLAS FORD DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		NV

General Provider Information

NPI Number	:	1740699743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS FORD DPT

Provider Business Mailing Address
First Line	:	21200 KITTRIDGE ST APT 2251
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91303-3046
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 PLUMAS ST
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89509-4515
Country	:	US
Telephone Number	:	775-829-7220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2014
Last Update Date	:	08/05/2014

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Directions to “ DR. NICHOLAS FORD DPT” Practice Location

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