Provider Demographics
NPI:1043830540
Name:FARAH, NATALIE JOHANNA (DPT)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:JOHANNA
Last Name:FARAH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 JOHNSON FERRY RD STE 202
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-5416
Mailing Address - Country:US
Mailing Address - Phone:470-275-5015
Mailing Address - Fax:628-239-0100
Practice Address - Street 1:123 W MADISON ST STE 200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-4632
Practice Address - Country:US
Practice Address - Phone:312-624-8102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700250332251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty