Provider Demographics
NPI:1689649188
Name:GOHARI, FARAH (RPT)
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:GOHARI
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 N CARRIAGE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4506
Mailing Address - Country:US
Mailing Address - Phone:316-612-4900
Mailing Address - Fax:316-612-4999
Practice Address - Street 1:545 N CARRIAGE PKWY
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4506
Practice Address - Country:US
Practice Address - Phone:316-612-4900
Practice Address - Fax:316-612-4999
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1102277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100336410BMedicaid
KS100336410BMedicaid