Individual
DR. PHILIP DAVID FORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D., ATC, LAT
Contact information
Practice address
1910 UNIVERSITY DR, BOISE, ID 83725-1710
(208) 426-4278
Mailing address
1910 UNIVERSITY DR, BOISE, ID 83725-1710
(208) 426-4278
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT527
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AT527
IDAHO STATE BOARD OF MEDICINE
ID
Enumeration date
05/30/2007
Last updated
04/15/2016
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