Provider Demographics
NPI:1467796052
Name:FORD, WALTER ELSWORTH III (LMP)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:ELSWORTH
Last Name:FORD
Suffix:III
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 BELLERIVE DR
Mailing Address - Street 2:APARTMENT 200
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8808
Mailing Address - Country:US
Mailing Address - Phone:509-366-4460
Mailing Address - Fax:
Practice Address - Street 1:110 COLUMBIA POINT DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4387
Practice Address - Country:US
Practice Address - Phone:509-946-7692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010307225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist