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General NPI Number Information
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NPI Number | 1104056761
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Entity Type | Individual
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Provider Name | DAVID MICHAEL FARRIS PT
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Gender | Male
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 10/23/2021
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Provider Practice Location Address
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Address Line | 1524 MALLORCA DR
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City | VISTA
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State | CA
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Zip | 92081-5047
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Country | US
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Telephone | 760-727-6063
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Fax |
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Provider Business Mailing Address
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Address Line | 400 CRAVEN RD
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City | SAN MARCOS
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State | CA
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Zip | 92078-4201
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Country | US
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Telephone | 760-727-6063
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 24934
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License Number State | CA
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