Provider Demographics
NPI:1932294527
Name:FORD, ERIC CHARLES (CNMT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:CHARLES
Last Name:FORD
Suffix:
Gender:M
Credentials:CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 E BROWN RD STE 15
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-5432
Mailing Address - Country:US
Mailing Address - Phone:480-807-3491
Mailing Address - Fax:480-807-3794
Practice Address - Street 1:2830 E BROWN RD
Practice Address - Street 2:SUITE 15
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-5430
Practice Address - Country:US
Practice Address - Phone:480-807-3491
Practice Address - Fax:480-807-3794
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-05561225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist