Provider Demographics
NPI:1871243360
Name:FARAJ, ADBIA (PTA)
Entity Type:Individual
Prefix:
First Name:ADBIA
Middle Name:
Last Name:FARAJ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N GREENVILLE AVE APT 1321
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-9147
Mailing Address - Country:US
Mailing Address - Phone:330-409-3947
Mailing Address - Fax:
Practice Address - Street 1:6101 OHIO DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2720
Practice Address - Country:US
Practice Address - Phone:972-468-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-27
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH013072225200000X
TX2167068225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant