Healthcare Provider Details

I. General information

NPI: 1437761129
Provider Name (Legal Business Name): ANDREW FORD PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2020
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 ADAM SHEPHERD PKWY
SHEPHERDSVILLE KY
40165-6640
US

IV. Provider business mailing address

431 ADAM SHEPHERD PKWY STE 1
SHEPHERDSVILLE KY
40165-6640
US

V. Phone/Fax

Practice location:
  • Phone: 502-921-0272
  • Fax:
Mailing address:
  • Phone: 502-921-0272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number008217
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05013891A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: