Provider Demographics
NPI:1558419697
Name:FARNHAM, DANIEL (PT, ATC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:FARNHAM
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 WELLNESS DR
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-2088
Mailing Address - Country:US
Mailing Address - Phone:802-860-1358
Mailing Address - Fax:802-860-1093
Practice Address - Street 1:115 WELLNESS DR
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-2088
Practice Address - Country:US
Practice Address - Phone:802-860-1358
Practice Address - Fax:802-860-1093
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003451225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVN3109Medicare ID - Type Unspecified