Provider Demographics
NPI:1467759027
Name:FORD, THOMAS DOYLE (PTA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DOYLE
Last Name:FORD
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 RIVER TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-3920
Mailing Address - Country:US
Mailing Address - Phone:828-302-2056
Mailing Address - Fax:828-495-7700
Practice Address - Street 1:21 RIVER TERRACE CT
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-3920
Practice Address - Country:US
Practice Address - Phone:828-302-2056
Practice Address - Fax:828-495-7700
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4041225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant