Provider Demographics
NPI:1902026040
Name:FARAHANI, KASHA (DPT)
Entity Type:Individual
Prefix:
First Name:KASHA
Middle Name:
Last Name:FARAHANI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9430 VERVAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3527
Mailing Address - Country:US
Mailing Address - Phone:858-245-6957
Mailing Address - Fax:
Practice Address - Street 1:17895 CAMINITO PINERO UNIT 257
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4806
Practice Address - Country:US
Practice Address - Phone:858-245-6957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27915225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist