Provider Demographics
NPI:1851789143
Name:FAHRNER, JOHNATHAN RICHARD
Entity Type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:RICHARD
Last Name:FAHRNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6318 FM 1488 RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-2763
Mailing Address - Country:US
Mailing Address - Phone:936-273-0808
Mailing Address - Fax:936-273-0860
Practice Address - Street 1:6318 FM 1488 RD
Practice Address - Street 2:SUITE 150
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-2763
Practice Address - Country:US
Practice Address - Phone:936-273-0808
Practice Address - Fax:936-273-0860
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1253329225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist