Provider Demographics
NPI:1902679624
Name:FARRAR, MALIA R (PT)
Entity Type:Individual
Prefix:
First Name:MALIA
Middle Name:R
Last Name:FARRAR
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 1:171 NORWICH AVE
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1274
Mailing Address - Country:US
Mailing Address - Phone:860-537-3014
Mailing Address - Fax:860-537-1420
Practice Address - Street 1:21C LIBERTY DR
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:CT
Practice Address - Zip Code:06248-1589
Practice Address - Country:US
Practice Address - Phone:860-228-4883
Practice Address - Fax:860-228-0612
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist