Provider Demographics
NPI:1679647911
Name:GRANT-FORD, MARSHA L (ATC, PHD)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:L
Last Name:GRANT-FORD
Suffix:
Gender:F
Credentials:ATC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 PENOBSCOT ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2017
Mailing Address - Country:US
Mailing Address - Phone:973-470-9968
Mailing Address - Fax:973-470-9964
Practice Address - Street 1:1 NORMAL AVE
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1624
Practice Address - Country:US
Practice Address - Phone:973-655-5243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000542002255A2300X
PART000129A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer