MEDICARE: HANNA ELIZABETH FARKAS PTA

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	225200000X	Physical Therapy Assistant	5502005711	MI

General Provider Information

NPI Number	:	1639637523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNA ELIZABETH FARKAS PTA

Provider Business Mailing Address
First Line	:	3367 PANORAMA LN
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-8065
Country	:	US
Telephone Number	:	231-620-5145
Fax Number	:

Provider Business Practice Location Address
First Line	:	3367 PANORAMA LN
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-8065
Country	:	US
Telephone Number	:	231-620-5145
Fax Number	:

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

Provider Enumeration Date	:	03/09/2019
Last Update Date	:	03/09/2019

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