MEDICARE: TOMEKEA FORDE PTA

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	PTA 23878	FL

General Provider Information

NPI Number	:	1922405471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOMEKEA FORDE PTA

Provider Business Mailing Address
First Line	:	1709 TERRA COTTA DR
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33404-1860
Country	:	US
Telephone Number	:	561-370-8049
Fax Number	:

Provider Business Practice Location Address
First Line	:	1709 TERRA COTTA DR
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33404-1860
Country	:	US
Telephone Number	:	561-370-8049
Fax Number	:

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

Provider Enumeration Date	:	11/28/2014
Last Update Date	:	11/28/2014

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