Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1157167 | TX |
NPI | 1326206665 |
---|---|
Provider Name | Mr. Brandon R Ford |
First Address | Tuscola, TX 79562-2128 |
Second Address | Ballinger, TX 76821-2418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2008 |
Last Update Date | 22/05/2008 |