Provider Demographics
NPI:1841754546
Name:FORD, VANESIA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:VANESIA
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9750 CONNECTICUT ST
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4635
Mailing Address - Country:US
Mailing Address - Phone:239-390-3978
Mailing Address - Fax:239-206-4634
Practice Address - Street 1:9750 CONNECTICUT ST
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4635
Practice Address - Country:US
Practice Address - Phone:239-390-3978
Practice Address - Fax:239-206-4634
Is Sole Proprietor?:No
Enumeration Date:2019-01-27
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist