Healthcare Provider Details

I. General information

NPI: 1043545924
Provider Name (Legal Business Name): REBECCA MARIE FARAHAT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 E KATELLA AVE
ORANGE CA
92867-5045
US

IV. Provider business mailing address

2384 SUNNINGDALE DR
TUSTIN CA
92782-1090
US

V. Phone/Fax

Practice location:
  • Phone: 714-501-7028
  • Fax:
Mailing address:
  • Phone: 949-751-7398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number0314411
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number35185
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: