Provider Demographics
NPI:1316154453
Name:FORD, RHONDA DARLENE (LMT)
Entity type:Individual
Prefix:MISS
First Name:RHONDA
Middle Name:DARLENE
Last Name:FORD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 N ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-2963
Mailing Address - Country:US
Mailing Address - Phone:321-698-1519
Mailing Address - Fax:321-868-6963
Practice Address - Street 1:236 N ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-2963
Practice Address - Country:US
Practice Address - Phone:321-698-1519
Practice Address - Fax:321-868-6963
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA22058172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist