Provider Demographics
NPI:1528650090
Name:FARRIS, SEAN (DPT)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:FARRIS
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 1:5210 NC 27 E
Mailing Address - Street 2:
Mailing Address - City:COATS
Mailing Address - State:NC
Mailing Address - Zip Code:27521-9596
Mailing Address - Country:US
Mailing Address - Phone:828-514-3584
Mailing Address - Fax:
Practice Address - Street 1:1565 PURDUE DR STE 101A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5537
Practice Address - Country:US
Practice Address - Phone:910-484-8492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-06
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20223225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist