Provider Demographics
NPI:1548421480
Name:FORD, PEGGY A (MS, PT)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:A
Last Name:FORD
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BUTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4426
Mailing Address - Country:US
Mailing Address - Phone:732-741-5986
Mailing Address - Fax:732-842-9473
Practice Address - Street 1:5 BUTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4426
Practice Address - Country:US
Practice Address - Phone:732-741-5986
Practice Address - Fax:732-842-9473
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00273600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist