Healthcare Provider Details

I. General information

NPI: 1053529222
Provider Name (Legal Business Name): THE FORD GROUP, LMT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W GRANADA BLVD SUITE G6
ORMOND BEACH FL
32174-9485
US

IV. Provider business mailing address

17 REMINGTON RD
ORMOND BEACH FL
32174-2528
US

V. Phone/Fax

Practice location:
  • Phone: 386-677-7123
  • Fax:
Mailing address:
  • Phone: 386-437-4221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number07-20029
License Number StateFL

VIII. Authorized Official

Name: MRS. AURORA JOY FORD
Title or Position: OWNER, MASSAGE THERAPIST
Credential: LMT
Phone: 13866797577