Healthcare Provider Details

I. General information

NPI: 1255959102
Provider Name (Legal Business Name): NOAH SPENCER FORD PT, DPT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19500 SANDRIDGE WAY STE 230
LANSDOWNE VA
20176-3689
US

IV. Provider business mailing address

19500 SANDRIDGE WAY STE 230
LANSDOWNE VA
20176-3689
US

V. Phone/Fax

Practice location:
  • Phone: 703-724-7474
  • Fax: 703-724-9232
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2305215797
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: