Active NPI
Jennifer Lynn Farris, P.T.
- Physical Therapist
- Santa Rosa Beach, FL
National Provider Identifier
1407052095
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PTH3809
- Practice address
- 249 Mack Bayou Loop
Ste 101
Santa Rosa Beach, FL 32459-7197 - Phone
- (850) 622-0842
- NPI assigned
- Jun 21, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PTH3809 | AL | Primary |
Addresses
Primary practice location
249 Mack Bayou Loop
Ste 101
Santa Rosa Beach, FL 32459-7197
Mailing address
PO Box 370
Fortson, GA 31808-0370
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTH3809 | AL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Rehab Management, LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Navarre, FL
- NPI 1821014390
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591574400000",
"number": "1407052095",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 370",
"city": "FORTSON",
"state": "GA",
"postal_code": "318080370",
"fax_number": "706-494-3008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "249 MACK BAYOU LOOP",
"address_2": "STE 101",
"city": "SANTA ROSA BEACH",
"state": "FL",
"postal_code": "324597197",
"telephone_number": "850-622-0842"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARRIS",
"first_name": "JENNIFER",
"middle_name": "LYNN",
"name_prefix": "Miss",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-21",
"last_updated": "2020-06-08",
"certification_date": "2020-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AL",
"license": "PTH3809",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.