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General NPI Number Information
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NPI Number | 1174323034
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Entity Type | Individual
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Provider Name | FATIMA NEFERITI FORD RYT, THAI YOGA MASSA
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Gender | Female
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 3322 E. 90TH ST
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City | CHICAGO
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State | IL
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Zip | 60617
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Country | US
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Telephone | 773-853-4371
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Fax |
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Provider Business Mailing Address
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Address Line | 8432 S MACKINAW AV
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City | CHICAGO
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State | IL
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Zip | 60617
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Country | US
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Telephone | 317-480-0584
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number |
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License Number State |
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