MEDICARE: JASON 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	225200000X	Physical Therapy Assistant	2116631	TX

General Provider Information

NPI Number	:	1427422450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON FORD

Provider Business Mailing Address
First Line	:	2312 FOXGLEN CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-1715
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2312 FOXGLEN CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-1715
Country	:	US
Telephone Number	:	214-783-9818
Fax Number	:

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

Provider Enumeration Date	:	11/13/2015
Last Update Date	:	11/13/2015

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Directions to “ JASON FORD ” Practice Location

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