Provider Demographics
NPI:1841442100
Name:FARLEY, BECKY GWEN (PT, MS, PHD)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:GWEN
Last Name:FARLEY
Suffix:
Gender:F
Credentials:PT, MS, PHD
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:GWEN
Other - Last Name:BOURGEOIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3749 E HELENA STRA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-1929
Mailing Address - Country:US
Mailing Address - Phone:520-591-5821
Mailing Address - Fax:
Practice Address - Street 1:140 W FORT LOWELL RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-3812
Practice Address - Country:US
Practice Address - Phone:520-591-5346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19132251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology