Provider Demographics
NPI:1942247051
Name:FARRAH, ROBERT EDWIN (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDWIN
Last Name:FARRAH
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 1:2394 N BIG OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-6149
Mailing Address - Country:US
Mailing Address - Phone:479-973-9709
Mailing Address - Fax:
Practice Address - Street 1:802 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5364
Practice Address - Country:US
Practice Address - Phone:479-751-3860
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR1008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S699Medicare ID - Type Unspecified