Provider Demographics
NPI:1063851210
Name:FARRER, VANESSA COLLEEN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:COLLEEN
Last Name:FARRER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1765 JUAREZ ST
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-4005
Mailing Address - Country:US
Mailing Address - Phone:831-601-4811
Mailing Address - Fax:
Practice Address - Street 1:700 CASS ST
Practice Address - Street 2:116
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2916
Practice Address - Country:US
Practice Address - Phone:831-372-0651
Practice Address - Fax:831-372-0655
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38627225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist