Provider Demographics
NPI:1730552381
Name:FARREY, LORETTA
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:FARREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S74W17045 JANESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-9701
Mailing Address - Country:US
Mailing Address - Phone:414-422-4678
Mailing Address - Fax:414-422-4735
Practice Address - Street 1:S74W17045 JANESVILLE RD
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-9701
Practice Address - Country:US
Practice Address - Phone:414-422-4678
Practice Address - Fax:414-422-4735
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4060-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist