Provider Demographics
NPI:1992002653
Name:FORD, MARCELLA M (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:MARCELLA
Middle Name:M
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 1:600 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1755
Mailing Address - Country:US
Mailing Address - Phone:716-282-6765
Mailing Address - Fax:716-282-6725
Practice Address - Street 1:600 PINE AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1755
Practice Address - Country:US
Practice Address - Phone:716-282-6765
Practice Address - Fax:716-282-6725
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033045-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist