Provider Demographics
NPI:1699732321
Name:FORD, PATRICK JOHN (PT)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:JOHN
Last Name:FORD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 S HALCYON RD
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3115
Mailing Address - Country:US
Mailing Address - Phone:805-481-5656
Mailing Address - Fax:805-481-5749
Practice Address - Street 1:117 S HALCYON RD
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3115
Practice Address - Country:US
Practice Address - Phone:805-481-5656
Practice Address - Fax:805-481-5749
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16678Medicare ID - Type UnspecifiedGROUP
CAWPT6466AMedicare ID - Type Unspecified