Healthcare Provider Details

I. General information

NPI: 1174323034
Provider Name (Legal Business Name): FATIMA NEFERITI FORD RYT, THAI YOGA MASSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3322 E. 90TH ST
CHICAGO IL
60617
US

IV. Provider business mailing address

8432 S MACKINAW AV
CHICAGO IL
60617
US

V. Phone/Fax

Practice location:
  • Phone: 773-853-4371
  • Fax:
Mailing address:
  • Phone: 317-480-0584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: