Provider Demographics
NPI:1609044759
Name:FARMER, CASSIE MARLENA
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:MARLENA
Last Name:FARMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1005
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-1005
Mailing Address - Country:US
Mailing Address - Phone:912-375-2009
Mailing Address - Fax:912-379-0081
Practice Address - Street 1:147 S TALLAHASSEE ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-6466
Practice Address - Country:US
Practice Address - Phone:912-375-2009
Practice Address - Fax:912-379-0081
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist