MEDICARE: KSENIA FORD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	12436	SC

General Provider Information

NPI Number	:	1184356289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KSENIA FORD

Provider Business Mailing Address
First Line	:	306 9TH AVE N APT 5
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-3715
Country	:	US
Telephone Number	:	843-360-6469
Fax Number	:

Provider Business Practice Location Address
First Line	:	306 9TH AVE N APT 5
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-3715
Country	:	US
Telephone Number	:	843-360-6469
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2022
Last Update Date	:	06/28/2022

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Directions to “ KSENIA FORD ” Practice Location

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