Provider Demographics
NPI:1831433507
Name:FORDHAM, DEBORAH A (PTA)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:A
Last Name:FORDHAM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:A
Other - Last Name:NEUBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:25 JONAS DR
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-2708
Mailing Address - Country:US
Mailing Address - Phone:508-539-0292
Mailing Address - Fax:
Practice Address - Street 1:359 JONES RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-3341
Practice Address - Country:US
Practice Address - Phone:508-457-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant