Healthcare Provider Details

I. General information

NPI: 1790707115
Provider Name (Legal Business Name): HAYDEN T FORD III PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TOM FORD III PT

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6708 TAYLOR CIR
MONTGOMERY AL
36117-3411
US

IV. Provider business mailing address

6400 WYNWOOD PL
MONTGOMERY AL
36117-3459
US

V. Phone/Fax

Practice location:
  • Phone: 334-220-9550
  • Fax: 334-269-7559
Mailing address:
  • Phone: 334-220-9550
  • Fax: 334-277-2526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH3748
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: