Provider Demographics
NPI:1003793639
Name:FARLEY, TANNER JOSEPH (DPT)
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:JOSEPH
Last Name:FARLEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 NW SHADDEN DR
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6638
Mailing Address - Country:US
Mailing Address - Phone:971-678-6331
Mailing Address - Fax:
Practice Address - Street 1:2241 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-2811
Practice Address - Country:US
Practice Address - Phone:503-982-8544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR65857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist