Provider Demographics
NPI:1598785461
Name:FORD, ANDREW MARX (ATC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:MARX
Last Name:FORD
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 JAMES RIVER TRCE
Mailing Address - Street 2:
Mailing Address - City:LANGLEY AFB
Mailing Address - State:VA
Mailing Address - Zip Code:23665-2419
Mailing Address - Country:US
Mailing Address - Phone:617-838-6667
Mailing Address - Fax:
Practice Address - Street 1:1423 WALTHAM LN
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-7763
Practice Address - Country:US
Practice Address - Phone:617-838-6667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0038012255A2300X
VA01260033872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer