Provider Demographics
NPI:1902981194
Name:FARREN, PHYLLIS L (MS, PT)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:L
Last Name:FARREN
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 GREGOR MENDEL CIR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-2315
Mailing Address - Country:US
Mailing Address - Phone:864-229-2663
Mailing Address - Fax:864-323-0510
Practice Address - Street 1:102 GREGOR MENDEL CIR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2315
Practice Address - Country:US
Practice Address - Phone:864-229-2663
Practice Address - Fax:864-227-9510
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4489225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00611142OtherRAILROAD MEDICARE MEMBER PTAN
SC8624Medicare PIN
SCP00611142OtherRAILROAD MEDICARE MEMBER PTAN