Provider Demographics
NPI:1043085640
Name:FARRIS, VANESSA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:FARRIS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2157 W 3100 N
Mailing Address - Street 2:
Mailing Address - City:FARR WEST
Mailing Address - State:UT
Mailing Address - Zip Code:84404-9615
Mailing Address - Country:US
Mailing Address - Phone:801-866-4698
Mailing Address - Fax:
Practice Address - Street 1:3890 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2319
Practice Address - Country:US
Practice Address - Phone:801-387-7678
Practice Address - Fax:801-387-8539
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-24
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7982590-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer