Provider Demographics
NPI:1710645551
Name:FORD, NANCY EATON (MSPT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:EATON
Last Name:FORD
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2701
Mailing Address - Country:US
Mailing Address - Phone:860-570-8211
Mailing Address - Fax:860-570-8250
Practice Address - Street 1:2021 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2701
Practice Address - Country:US
Practice Address - Phone:860-570-8211
Practice Address - Fax:860-570-8250
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003003989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist