1841403250 NPI number — MRS. HEATHER MICHELE FORD P.T.

Table of content: MRS. HEATHER MICHELE FORD P.T. (NPI 1841403250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841403250 NPI number — MRS. HEATHER MICHELE FORD P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORD
Provider First Name:
HEATHER
Provider Middle Name:
MICHELE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GORMLEY
Provider Other First Name:
HEATHER
Provider Other Middle Name:
MICHELE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841403250
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6202 HERONS NEST CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK RIDGE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27310-6601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-483-6313
Provider Business Mailing Address Fax Number:
336-878-8859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4008 PIEDMONT PKWY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-878-8970
Provider Business Practice Location Address Fax Number:
336-878-8859
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  004633 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 9211 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 13675 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9211 . This is a "LISENCE #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: GP-212 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: KY#004633 . This is a "LISENCE #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 13675 . This is a "STATE PROVIDER LICENSE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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