Provider Demographics
NPI:1447478805
Name:FARNHAM, DIANE RUSSELL (PT)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:RUSSELL
Last Name:FARNHAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 GARRETT RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-9563
Mailing Address - Country:US
Mailing Address - Phone:607-273-3319
Mailing Address - Fax:
Practice Address - Street 1:114 W BUFFALO ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4132
Practice Address - Country:US
Practice Address - Phone:607-272-8869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist