Provider Demographics
NPI:1720001555
Name:FARABAUGH, MATTHEW (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:FARABAUGH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 SPRINGER RD
Mailing Address - Street 2:
Mailing Address - City:NICKTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15762-8617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:290 HAIDA AVENUE
Practice Address - Street 2:MINERS MEDICAL CENTER
Practice Address - City:HASTINGS
Practice Address - State:PA
Practice Address - Zip Code:16646
Practice Address - Country:US
Practice Address - Phone:814-247-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist