Provider Demographics
NPI:1619213782
Name:FARWICK, LAUREN N (PT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:N
Last Name:FARWICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 SEVERIN DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3806
Mailing Address - Country:US
Mailing Address - Phone:619-589-2606
Mailing Address - Fax:619-464-0900
Practice Address - Street 1:3130 BONITA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3263
Practice Address - Country:US
Practice Address - Phone:619-422-8315
Practice Address - Fax:619-422-4489
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH013992225100000X
CA39773225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA5597Medicare UPIN