Provider Demographics
NPI:1912926221
Name:FARLEY, JOANNE MARY (PT)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:MARY
Last Name:FARLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E GLADSTONE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1903
Mailing Address - Country:US
Mailing Address - Phone:909-592-7336
Mailing Address - Fax:
Practice Address - Street 1:801 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 130
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-2628
Practice Address - Country:US
Practice Address - Phone:909-623-1954
Practice Address - Fax:909-623-4988
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13970225100000X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT13970OtherPHYSICAL THERAPY LISCENSE