Provider Demographics
NPI:1396910444
Name:FARLEIGH GARDNER, PAMELA ANNE (PTA)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ANNE
Last Name:FARLEIGH GARDNER
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 1:90 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:MATAMORAS
Mailing Address - State:PA
Mailing Address - Zip Code:18336-2004
Mailing Address - Country:US
Mailing Address - Phone:570-504-5653
Mailing Address - Fax:
Practice Address - Street 1:220 WHITE PLAINS ROAD
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NEW YORK
Practice Address - Zip Code:10591
Practice Address - Country:UM
Practice Address - Phone:914-631-9020
Practice Address - Fax:914-631-9028
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE001601L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant