Healthcare Provider Details

I. General information

NPI: 1801375514
Provider Name (Legal Business Name): DENYSE FARRAR PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENYSE AU PTA

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 YOUNGSTOWN WARREN RD STE A
NILES OH
44446-4626
US

IV. Provider business mailing address

950 YOUNGSTOWN WARREN RD STE A
NILES OH
44446-4626
US

V. Phone/Fax

Practice location:
  • Phone: 330-505-1606
  • Fax:
Mailing address:
  • Phone: 330-505-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA009065
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: