Provider Demographics
NPI:1417676214
Name:FARR, LANA SHAWNA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:SHAWNA
Last Name:FARR
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 1:3307 GRAND AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6551
Mailing Address - Country:US
Mailing Address - Phone:406-655-9060
Mailing Address - Fax:
Practice Address - Street 1:3307 GRAND AVE STE 203
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6551
Practice Address - Country:US
Practice Address - Phone:406-655-9060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-24494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTPTP-PT-LIC-24494OtherDRIVER'S LICENSE