Provider Demographics
NPI:1508012048
Name:FARLEY, LAURA ANN (PTA)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANN
Last Name:FARLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 BISON LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:KY
Mailing Address - Zip Code:42453-9713
Mailing Address - Country:US
Mailing Address - Phone:270-669-4357
Mailing Address - Fax:
Practice Address - Street 1:419 N SEMINARY ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1515
Practice Address - Country:US
Practice Address - Phone:270-821-5564
Practice Address - Fax:270-821-6211
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA00308225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant