MEDICARE: CHERYL A FARNSWORTH MPT

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	284377-2401	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	CJ9402	OTHER	UT	RAILROAD MEDICARE
6	005580701	OTHER	UT	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5417	OTHER	UT	DMBA
2	6400227	OTHER	UT	UNITED HEALTHCARE
3	QM0000047851	OTHER	UT	ALTIUS
4	61201	OTHER	UT	PEHP
7	870388269BR1	OTHER	UT	EDUCATORS MUTUAL
8	2988511	OTHER	UT	CIGNA

General Provider Information

NPI Number	:	1720089485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL A FARNSWORTH MPT

Provider Business Mailing Address
First Line	:	1151 EAST 3900 SOUTH STE. B-240
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124
Country	:	US
Telephone Number	:	801-685-9212
Fax Number	:	801-685-9195

Provider Business Practice Location Address
First Line	:	1151 EAST 3900 SOUTH
Second Line	:	STE B-240
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124
Country	:	US
Telephone Number	:	801-685-9212
Fax Number	:	801-685-9195

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	07/31/2008

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