Provider Demographics
NPI:1407988975
Name:FARRAN, JEFFREY FRED (PT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:FRED
Last Name:FARRAN
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 1:11671 FOUNTAINS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4784
Mailing Address - Country:US
Mailing Address - Phone:763-585-0605
Mailing Address - Fax:
Practice Address - Street 1:11671 FOUNTAINS DR STE 200
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4784
Practice Address - Country:US
Practice Address - Phone:763-585-0605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist