Provider Demographics
NPI:1023025483
Name:SMITH, FARRAH E (PT)
Entity Type:Individual
Prefix:
First Name:FARRAH
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4304 MULLIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3475
Mailing Address - Country:US
Mailing Address - Phone:972-262-9972
Mailing Address - Fax:972-262-9986
Practice Address - Street 1:3824 S CARRIER PKWY
Practice Address - Street 2:SUITE 470
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-6644
Practice Address - Country:US
Practice Address - Phone:972-262-9972
Practice Address - Fax:972-262-9986
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2014-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11465312251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic