Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA-2565 | AR |
NPI | 1003274218 |
---|---|
Provider Name | Ahna Farrar |
First Address | Magnolia, AR 71753-9579 |
Second Address | Magnolia, AR 71753-4305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2016 |
Last Update Date | 02/02/2016 |