Provider Demographics
NPI:1851902233
Name:FORD, GENA M (LMT)
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:M
Last Name:FORD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 SEMINOLE ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-7665
Mailing Address - Country:US
Mailing Address - Phone:417-894-7798
Mailing Address - Fax:
Practice Address - Street 1:2117 W OWEN K GARRIOT
Practice Address - Street 2:INSIDE BEYOND BEAUTY
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703
Practice Address - Country:US
Practice Address - Phone:417-894-7798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK156882225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty