Provider Demographics
NPI:1053638494
Name:CALICA, FARAH PANTOJA (PT)
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:PANTOJA
Last Name:CALICA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 FALCON REACH DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-2695
Mailing Address - Country:US
Mailing Address - Phone:832-643-9285
Mailing Address - Fax:713-647-8106
Practice Address - Street 1:2011 FALCON REACH DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-2695
Practice Address - Country:US
Practice Address - Phone:832-643-9285
Practice Address - Fax:713-647-8106
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1190162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist