Provider Demographics
NPI:1235408675
Name:FORD, PATRICIA JOANNE
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JOANNE
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PAULS WAY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03868-8839
Mailing Address - Country:US
Mailing Address - Phone:603-337-5360
Mailing Address - Fax:
Practice Address - Street 1:105 PAULS WAY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03868-8839
Practice Address - Country:US
Practice Address - Phone:603-337-5360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPT1305OtherMAINE PHYSICAL THERAPY LICENSE