Healthcare Provider Details

I. General information

NPI: 1881528446
Provider Name (Legal Business Name): CIARA FORDE PT, DPT, CSCS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 SKYWAY CIR STE 111
MELBOURNE FL
32934-7401
US

IV. Provider business mailing address

400 N TAMPA ST, STE 1550 PMB 381219
TAMPA FL
33602-4719
US

V. Phone/Fax

Practice location:
  • Phone: 617-894-1638
  • Fax:
Mailing address:
  • Phone: 617-894-1638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CIARA P FORDE
Title or Position: OWNER/FOUNDER
Credential: PT, DPT, CSCS
Phone: 617-894-1638