Provider Demographics
NPI:1336345636
Name:FORD, REBECCA ANN (PT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:FORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26595 CEDARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5468
Mailing Address - Country:US
Mailing Address - Phone:419-874-5472
Mailing Address - Fax:
Practice Address - Street 1:2920 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-1716
Practice Address - Country:US
Practice Address - Phone:419-242-7458
Practice Address - Fax:419-252-6514
Is Sole Proprietor?:No
Enumeration Date:2007-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist