Healthcare Provider Details

I. General information

NPI: 1851053722
Provider Name (Legal Business Name): EISSAM GEORGE ALFARRAJ PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: EISSAM GEORGE FARRAJ PT

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 CRESCENT PL
GAHANNA OH
43230-3086
US

IV. Provider business mailing address

340 POLARIS PKWY
WESTERVILLE OH
43082-7971
US

V. Phone/Fax

Practice location:
  • Phone: 614-545-7900
  • Fax: 614-545-7901
Mailing address:
  • Phone: 614-839-2300
  • Fax: 614-839-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: