Provider Demographics
NPI:1093472482
Name:DEEP, FAROOQ (PT)
Entity Type:Individual
Prefix:
First Name:FAROOQ
Middle Name:
Last Name:DEEP
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 RIVER RIDGE PKWY APT 322
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-6739
Mailing Address - Country:US
Mailing Address - Phone:737-346-1221
Mailing Address - Fax:
Practice Address - Street 1:1150 RIVER RIDGE PKWY APT 322
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-6739
Practice Address - Country:US
Practice Address - Phone:737-346-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-20
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1355292225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist