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General NPI Number Information
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NPI Number | 1316233224
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Entity Type | Individual
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Provider Name | RODNEY DEAN FORD JR. ATC
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Gender | Male
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Dates
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Enumeration Date | 06/20/2011
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Last Update Date | 06/20/2011
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Provider Practice Location Address
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Address Line | 4550 MEMORIAL DR. OFFICE CENTER ONE STE G100
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City | BELLEVILLE
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State | IL
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Zip | 62226-5372
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Country | US
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Telephone | 618-236-2246
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Fax | 618-236-2315
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Provider Business Mailing Address
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Address Line | 4550 MEMORIAL DR. OFFICE CENTER ONE STE G100
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City | BELLEVILLE
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State | IL
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Zip | 62226-5372
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Country | US
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Telephone | 618-236-2246
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Fax | 618-236-2315
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 096.001223
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2000164612
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License Number State | MO
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