Provider Demographics
NPI:1386995264
Name:FARRIS, CHERYL (PTA)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:
Last Name:FARRIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-1536
Mailing Address - Country:US
Mailing Address - Phone:419-483-5000
Mailing Address - Fax:419-483-4273
Practice Address - Street 1:101 AUXILIARY DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9492
Practice Address - Country:US
Practice Address - Phone:419-483-5000
Practice Address - Fax:419-483-4273
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07149225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant