=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053904516
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HANNAH FORD PT, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2021
-----------------------------------------------------
Last Update Date | 02/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29255 NORTHWESTERN HWY STE 300
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48034-5742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-353-1234
-----------------------------------------------------
Fax | 248-353-1211
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2318 COOLIDGE HWY APT 202
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48084-3629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-453-2570
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 5501019920
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------