Provider Demographics
NPI:1215417589
Name:FORD, CHRISTY NICOLE (PTA)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:NICOLE
Last Name:FORD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 TASCOSA RD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-1504
Mailing Address - Country:US
Mailing Address - Phone:806-322-8387
Mailing Address - Fax:
Practice Address - Street 1:1020 TASCOSA RD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1504
Practice Address - Country:US
Practice Address - Phone:806-322-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2056012225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant