Individual
JENNIFER LYNNE FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
557 PARK ST APT 6, LEWISTON, ID 83501-2581
(208) 305-4636
Mailing address
557 PARK ST APT 6, LEWISTON, ID 83501-2581
(208) 305-4636
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-2149
ID
Other
Enumeration date
05/31/2008
Last updated
05/31/2008
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