Provider Demographics
NPI:1043734478
Name:FORDHAM, COLBY EDWARD (PT)
Entity Type:Individual
Prefix:
First Name:COLBY
Middle Name:EDWARD
Last Name:FORDHAM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 EXECUTIVE PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5390
Mailing Address - Country:US
Mailing Address - Phone:910-423-5550
Mailing Address - Fax:910-423-5552
Practice Address - Street 1:501 EXECUTIVE PL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5390
Practice Address - Country:US
Practice Address - Phone:910-423-5550
Practice Address - Fax:910-423-5552
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP17284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist