Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT 3108 | AR |
NPI | 1104078278 |
---|---|
Provider Name | Mrs. Amy Elizabeth Ford |
First Address | Jonesboro, AR 72404-9119 |
Second Address | Jonesboro, AR 72404-9119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2008 |
Last Update Date | 03/09/2019 |