Shannon Ford, PTA
Individual provider Active NPI Physical Therapy Assistant · Starke, FL
NPI 1184089005 · NPPES record last updated Dec 18, 2015
Key facts
- NPI
- 1184089005
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- PTA26179 (FL)
- Practice address
- 7195 NW 215TH Way
Starke, FL 32091-5174 - Phone
- (386) 623-3468
- NPI assigned
- Dec 18, 2015
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA26179 | FL | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA26179 | FL | Yes |
Addresses
Primary practice location
7195 NW 215TH Way
Starke, FL 32091-5174
Mailing address
7195 NW 215TH Way
Starke, FL 32091-5174
Phone (386) 623-3468
Other providers in Starke, FL
- Alexis L Ferebee
- Nadine Fiege
- Marcia Marie Fletcher
- Florida Department of Health
- Lynette Fodor
- Brianna N Forsyth
- Dorothy Fox
- Charles James Franson Jr.
- Tiffany Jade Harris Fraser
- Amanda Futch
All providers in Starke, FL · Physical Therapy Assistant in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 18, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.