Provider Demographics
NPI:1588150270
Name:FORD, STEPHEN SWYGERT (PT, DPT, CSCS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:SWYGERT
Last Name:FORD
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5759 EAGLES NEST BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-6231
Mailing Address - Country:US
Mailing Address - Phone:903-405-4899
Mailing Address - Fax:903-638-2741
Practice Address - Street 1:5759 EAGLES NEST BLVD STE 4
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-6231
Practice Address - Country:US
Practice Address - Phone:903-405-4899
Practice Address - Fax:903-638-2741
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1309347225100000X, 2251X0800X
SC9640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX390685101Medicaid
TX8JZ286OtherBCBS