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General NPI Number Information
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NPI Number | 1710495544
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Entity Type | Individual
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Provider Name | HERBERT FORD JR. PHYSICAL THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 01/15/2018
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Last Update Date | 01/15/2018
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Provider Practice Location Address
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Address Line | 1400 E SOUTHERN AVE STE 310
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City | TEMPE
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State | AZ
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Zip | 85282-5695
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Country | US
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Telephone | 623-688-0946
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Fax |
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Provider Business Mailing Address
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Address Line | 7153 W TINA LN
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City | GLENDALE
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State | AZ
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Zip | 85310-5272
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Country | US
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Telephone | 623-205-9562
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Fax | 623-476-2707
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 6119
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN129482
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License Number State | AZ
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