Provider Demographics
NPI:1376596122
Name:FORD, NORMA IRIS (PT)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:IRIS
Last Name:FORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13125 N LA MONTANA DR
Mailing Address - Street 2:STE A-B
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-3781
Mailing Address - Country:US
Mailing Address - Phone:480-695-6913
Mailing Address - Fax:
Practice Address - Street 1:13125 N LA MONTANA DR
Practice Address - Street 2:STE A-B
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3781
Practice Address - Country:US
Practice Address - Phone:480-695-6913
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9416225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist