Provider Demographics
NPI:1083768659
Name:FORD, WELDANA (PT)
Entity Type:Individual
Prefix:MS
First Name:WELDANA
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:354 KENNON CIR
Mailing Address - Street 2:
Mailing Address - City:PALO PINTO
Mailing Address - State:TX
Mailing Address - Zip Code:76484-3738
Mailing Address - Country:US
Mailing Address - Phone:940-796-3673
Mailing Address - Fax:254-965-3618
Practice Address - Street 1:1052 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-4558
Practice Address - Country:US
Practice Address - Phone:254-965-3611
Practice Address - Fax:254-965-3618
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1050904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist