Provider Demographics
NPI:1275810269
Name:FARMER, ANDREW (PT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:FARMER
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 1:2700 BRASELTON HWY
Mailing Address - Street 2:STE 10-132
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-3262
Mailing Address - Country:US
Mailing Address - Phone:678-439-8320
Mailing Address - Fax:
Practice Address - Street 1:2700 BRASELTON HWY
Practice Address - Street 2:STE 10-132
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-3262
Practice Address - Country:US
Practice Address - Phone:678-439-8320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP13481225100000X
GAPT010541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist