Provider Demographics
NPI:1639637523
Name:FARKAS, HANNA ELIZABETH (PTA)
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:ELIZABETH
Last Name:FARKAS
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 1:3367 PANORAMA LN
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-8065
Mailing Address - Country:US
Mailing Address - Phone:231-620-5145
Mailing Address - Fax:
Practice Address - Street 1:3367 PANORAMA LN
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-8065
Practice Address - Country:US
Practice Address - Phone:231-620-5145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-09
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502005711225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant