Healthcare Provider Details

I. General information

NPI: 1881845709
Provider Name (Legal Business Name): ANGELA ANNETTE FORD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MARINER HEALTH WAY
ST AUGUSTINE FL
32086-3215
US

IV. Provider business mailing address

2222 SULLIVAN TRL
EASTON PA
18040-7958
US

V. Phone/Fax

Practice location:
  • Phone: 904-794-9988
  • Fax: 904-794-0898
Mailing address:
  • Phone: 800-944-9782
  • Fax: 610-438-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA19794
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: