Provider Demographics
NPI:1922405471
Name:FORDE, TOMEKEA (PTA)
Entity Type:Individual
Prefix:
First Name:TOMEKEA
Middle Name:
Last Name:FORDE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 TERRA COTTA DR
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-1860
Mailing Address - Country:US
Mailing Address - Phone:561-370-8049
Mailing Address - Fax:
Practice Address - Street 1:1709 TERRA COTTA DR
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-1860
Practice Address - Country:US
Practice Address - Phone:561-370-8049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-28
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 23878225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant