Provider Demographics
NPI:1588188247
Name:FARMER, DANIELLE REBECCA (DPT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:REBECCA
Last Name:FARMER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DANI
Other - Middle Name:
Other - Last Name:FARMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1001 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2125
Practice Address - Country:US
Practice Address - Phone:662-323-6360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS5456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist