Provider Demographics
NPI:1174323034
Name:FORD, FATIMA NEFERITI (RYT, THAI YOGA MASSA)
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:NEFERITI
Last Name:FORD
Suffix:
Gender:F
Credentials:RYT, THAI YOGA MASSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8432 S MACKINAW AV
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617
Mailing Address - Country:US
Mailing Address - Phone:317-480-0584
Mailing Address - Fax:
Practice Address - Street 1:3322 E. 90TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617
Practice Address - Country:US
Practice Address - Phone:773-853-4371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171100000XOther Service ProvidersAcupuncturist
No174400000XOther Service ProvidersSpecialist
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA