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General NPI Number Information
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NPI Number | 1891754875
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Entity Type | Individual
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Provider Name | JOHN DAVID FARR PT
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Gender | Male
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 10/16/2019
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Provider Practice Location Address
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Address Line | 1935 COUNTY ROAD B2 W STE 405
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City | ROSEVILLE
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State | MN
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Zip | 55113
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Country | US
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Telephone | 651-635-0578
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Fax |
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Provider Business Mailing Address
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Address Line | 1935 COUNTY ROAD B2 W STE 405
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City | ROSEVILLE
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State | MN
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Zip | 55113-2797
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Country | US
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Telephone | 651-635-0578
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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 | 5247
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License Number State | MN
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