Provider Demographics
NPI:1013393495
Name:FORD, SHANA JOYELLE (PT)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:JOYELLE
Last Name:FORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1755 HIGHWAY 34 E
Mailing Address - Street 2:STE 1300
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-3186
Mailing Address - Country:US
Mailing Address - Phone:404-931-5878
Mailing Address - Fax:770-254-7837
Practice Address - Street 1:3645 MARKETPLACE BLVD
Practice Address - Street 2:STE 160
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5747
Practice Address - Country:US
Practice Address - Phone:404-344-2823
Practice Address - Fax:404-629-3737
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2018-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAPT011761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist