Provider Demographics
NPI:1104525609
Name:FORD, CHRISTOPHER SHAWN (LMT, MMP)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SHAWN
Last Name:FORD
Suffix:
Gender:M
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 ALDEN WAY UNIT 2030
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-2479
Mailing Address - Country:US
Mailing Address - Phone:304-816-9672
Mailing Address - Fax:
Practice Address - Street 1:7201 ALDEN WAY UNIT 2030
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-2479
Practice Address - Country:US
Practice Address - Phone:304-816-9672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM06484225700000X
PAMSG014361225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist