MEDICARE: FARNES CLINIC, PS

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	225100000X	Physical Therapist	PT00000922	WA

General Provider Information

NPI Number	:	1255426490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARNES CLINIC, PS

Provider Business Mailing Address
First Line	:	4007 BRIDGEPORT WAY W STE C
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4330
Country	:	US
Telephone Number	:	253-565-7529
Fax Number	:	253-399-2508

Provider Business Practice Location Address
First Line	:	4007 BRIDGEPORT WAY W STE C
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4330
Country	:	US
Telephone Number	:	253-565-7529
Fax Number	:	253-399-2508

Authorized Official
Title or Position	:	PRESIDENT/ OWNER
Name	:	LARRY D FARNES
Credential	:	PT
Telephone Number	:	253-565-7529

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	10/22/2012

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