Individual
JERRY DONNELL FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
4251 LAHMEYER RD, FORT WAYNE, IN 46815-5676
(260) 432-4700
(260) 459-9262
Mailing address
4251 LAHMEYER RD, FORT WAYNE, IN 46815-5676
(260) 432-4700
(260) 459-9262
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001580A
IN
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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