Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 56633 | WI |
N | 2081S0010X | Sports Medicine | 56633 | WI |
N | 213ES0000X | Sports Medicine | 56633 | WI |
NPI | 1073838918 |
---|---|
Provider Name | Amy R Ford |
First Address | Summit, WI 53066-4899 |
Second Address | Summit, WI 53066-4899 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2010 |
Last Update Date | 18/11/2021 |