Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 070025033 | IL |
NPI | 1043830540 |
---|---|
Provider Name | Natalie Johanna Farah |
First Address | Marietta, GA 30068-5416 |
Second Address | Chicago, IL 60602-4632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2020 |
Last Update Date | 24/04/2020 |