Provider Demographics
NPI:1306661962
Name:FORD, JENNYFER MACIEL (DPT)
Entity type:Individual
Prefix:
First Name:JENNYFER
Middle Name:MACIEL
Last Name:FORD
Suffix:
Gender:F
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:CMR 402 BOX 1429
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180-0024
Mailing Address - Country:US
Mailing Address - Phone:175-400-0348
Mailing Address - Fax:
Practice Address - Street 1:LINA-PFAFF-STRASSE 2
Practice Address - Street 2:
Practice Address - City:KAISERSLAUTERN
Practice Address - State:RHINELAND-PALATINATE
Practice Address - Zip Code:67655
Practice Address - Country:DE
Practice Address - Phone:175-400-0348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT017127225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist