Provider Demographics
NPI:1588854129
Name:FORD PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:FORD PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HAYDEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:FORD
Authorized Official - Suffix:III
Authorized Official - Credentials:PHD, PT
Authorized Official - Phone:334-220-9550
Mailing Address - Street 1:6400 WYNWOOD PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3459
Mailing Address - Country:US
Mailing Address - Phone:334-220-9550
Mailing Address - Fax:334-277-2526
Practice Address - Street 1:7030 FAIN PARK DR
Practice Address - Street 2:SUITE 8
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7834
Practice Address - Country:US
Practice Address - Phone:334-220-9550
Practice Address - Fax:334-277-2526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51004722OtherBCBS
AL51525522OtherBCBS
AL58280Medicare UPIN