Provider Demographics
NPI:1548238520
Name:FARRIS, MICHAEL V (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:V
Last Name:FARRIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 MCKAY CT STE 100
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5780
Mailing Address - Country:US
Mailing Address - Phone:330-965-3899
Mailing Address - Fax:330-965-3839
Practice Address - Street 1:835 MCKAY CT STE 100
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5780
Practice Address - Country:US
Practice Address - Phone:330-965-3899
Practice Address - Fax:330-965-3839
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-09049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000369084OtherANTHEM BCBS
OH2536385Medicaid
OH341783341027OtherCARESOURCE
OH2536385Medicaid
OH000000369084OtherANTHEM BCBS