Healthcare Provider Details

I. General information

NPI: 1932294527
Provider Name (Legal Business Name): ERIC CHARLES FORD CNMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 E BROWN RD SUITE 15
MESA AZ
85213-5430
US

IV. Provider business mailing address

2830 E BROWN RD STE 15
MESA AZ
85213-5432
US

V. Phone/Fax

Practice location:
  • Phone: 480-807-3491
  • Fax: 480-807-3794
Mailing address:
  • Phone: 480-807-3491
  • Fax: 480-807-3794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-05561
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: