Provider Demographics
NPI:1699915454
Name:FORD, CHARITY NICOLE (LMT)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:NICOLE
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 1:4618 S THOMPSON ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-7467
Mailing Address - Country:US
Mailing Address - Phone:479-200-9245
Mailing Address - Fax:
Practice Address - Street 1:4618 S THOMPSON ST
Practice Address - Street 2:SUITE D
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-7467
Practice Address - Country:US
Practice Address - Phone:479-200-9245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3538225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist