Provider Demographics
NPI:1780844829
Name:FARNSWORTH-MARTIN, PAMELA JANE (MSPT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JANE
Last Name:FARNSWORTH-MARTIN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-1362
Mailing Address - Country:US
Mailing Address - Phone:507-649-2083
Mailing Address - Fax:
Practice Address - Street 1:127 GUNDERSON BLVD
Practice Address - Street 2:
Practice Address - City:KENYON
Practice Address - State:MN
Practice Address - Zip Code:55946-1014
Practice Address - Country:US
Practice Address - Phone:507-789-6134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34172251G0304X
MN84762251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics