Provider Demographics
NPI:1790707115
Name:FORD, HAYDEN T III (PT)
Entity Type:Individual
Prefix:
First Name:HAYDEN
Middle Name:T
Last Name:FORD
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:FORD
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:PT
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3748174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-25523OtherBCBS
AL51004722OtherBCBS
AL890012750Medicaid
AL58280Medicare UPIN
AL515-25523OtherBCBS