Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 2305203859 | VA |
NPI | 1063697522 |
---|---|
Provider Name | Kevin Bruce Ford |
First Address | Midlothian, VA 23112-4801 |
Second Address | Midlothian, VA 23112-4801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2008 |
Last Update Date | 27/10/2020 |