Provider Demographics
NPI:1124143649
Name:FARR, CLOVER A (PT)
Entity type:Individual
Prefix:
First Name:CLOVER
Middle Name:A
Last Name:FARR
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 1:2023 W VISTA WAY
Mailing Address - Street 2:SUITE S
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6030
Mailing Address - Country:US
Mailing Address - Phone:760-613-3374
Mailing Address - Fax:
Practice Address - Street 1:2023 W VISTA WAY
Practice Address - Street 2:SUITE S
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6030
Practice Address - Country:US
Practice Address - Phone:760-613-3374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23968225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist