Provider Demographics
NPI:1679039218
Name:FARR, CHANDRIA DOMINIQUE
Entity Type:Individual
Prefix:
First Name:CHANDRIA
Middle Name:DOMINIQUE
Last Name:FARR
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 1:2700 N PRICKETT RD STE 2B
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-7511
Mailing Address - Country:US
Mailing Address - Phone:501-247-8366
Mailing Address - Fax:844-272-0941
Practice Address - Street 1:12200 WESTHAVEN DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-5600
Practice Address - Country:US
Practice Address - Phone:501-476-3309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3952225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant