MEDICARE: DR. REBECCA MARIE FARAHAT DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	0314411	NY
2	225100000X	Physical Therapist	35185	CA

General Provider Information

NPI Number	:	1043545924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA MARIE FARAHAT DPT

Provider Business Mailing Address
First Line	:	2384 SUNNINGDALE DR
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92782-1090
Country	:	US
Telephone Number	:	949-751-7398
Fax Number	:

Provider Business Practice Location Address
First Line	:	1224 E KATELLA AVE
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92867-5045
Country	:	US
Telephone Number	:	714-501-7028
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2009
Last Update Date	:	02/26/2014

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