Provider Demographics
NPI:1841403250
Name:FORD, HEATHER MICHELE (PT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MICHELE
Last Name:FORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:MICHELE
Other - Last Name:GORMLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6202 HERONS NEST CT
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310-6601
Mailing Address - Country:US
Mailing Address - Phone:336-483-6313
Mailing Address - Fax:336-878-8859
Practice Address - Street 1:4008 PIEDMONT PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265
Practice Address - Country:US
Practice Address - Phone:336-878-8970
Practice Address - Fax:336-878-8859
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004633225100000X
OH9211225100000X
NC13675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9211OtherLISENCE #
KYGP-212Medicaid
KYKY#004633OtherLISENCE #
NC13675OtherSTATE PROVIDER LICENSE