Provider Demographics
NPI:1215789300
Name:FARMER, TASIA RENEE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:TASIA
Middle Name:RENEE
Last Name:FARMER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:MRS
Other - First Name:TASIA
Other - Middle Name:RENEE
Other - Last Name:FARMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TASIA DAVIS
Mailing Address - Street 1:159 GREY FAWN TRL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35757-6833
Mailing Address - Country:US
Mailing Address - Phone:256-457-8811
Mailing Address - Fax:
Practice Address - Street 1:655 US HIGHWAY 31 N
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-5003
Practice Address - Country:US
Practice Address - Phone:256-233-6613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer