Provider Demographics
NPI:1720089485
Name:FARNSWORTH, CHERYL A (MPT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:FARNSWORTH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 EAST 3900 SOUTH STE. B-240
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124
Mailing Address - Country:US
Mailing Address - Phone:801-685-9212
Mailing Address - Fax:801-685-9195
Practice Address - Street 1:1151 EAST 3900 SOUTH
Practice Address - Street 2:STE B-240
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124
Practice Address - Country:US
Practice Address - Phone:801-685-9212
Practice Address - Fax:801-685-9195
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT284377-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5417OtherDMBA
UT6400227OtherUNITED HEALTHCARE
UTQM0000047851OtherALTIUS
UT61201OtherPEHP
UTCJ9402OtherRAILROAD MEDICARE
UT005580701OtherMEDICARE ID
UT870388269BR1OtherEDUCATORS MUTUAL
UT2988511OtherCIGNA
UT5417OtherDMBA
UT870388269BR1OtherEDUCATORS MUTUAL