Basic Information
| Provider Information | |||||||||
| NPI: | 1144527862 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARQUHAR | ||||||||
| FirstName: | JENNA | ||||||||
| MiddleName: | UPTON | ||||||||
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| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | UPTON | ||||||||
| OtherFirstName: | JENNA | ||||||||
| OtherMiddleName: | CECILE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2129 HELTON DR | ||||||||
| Address2: | SUITE C | ||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356301069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567649304 | ||||||||
| FaxNumber: | 2567649343 | ||||||||
| Practice Location | |||||||||
| Address1: | 2129 HELTON DR | ||||||||
| Address2: | STE C | ||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356301069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567649304 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2011 | ||||||||
| LastUpdateDate: | 06/06/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTH6070 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.