Provider Demographics
NPI:1063697522
Name:FORD, KEVIN BRUCE (DPT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:BRUCE
Last Name:FORD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 W VILLAGE GREEN DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4801
Mailing Address - Country:US
Mailing Address - Phone:804-249-8277
Mailing Address - Fax:804-249-9690
Practice Address - Street 1:5001 W VILLAGE GREEN DR
Practice Address - Street 2:SUITE 203
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4801
Practice Address - Country:US
Practice Address - Phone:804-249-8277
Practice Address - Fax:804-249-9690
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052038592251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic