Provider Demographics
NPI:1023593803
Name:FARRIS, SARA JEANETTE (MSES, LAT, ATC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JEANETTE
Last Name:FARRIS
Suffix:
Gender:F
Credentials:MSES, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ATHLETIC TRAINING
Mailing Address - Street 2:1 CUMBERLAND SQ
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087
Mailing Address - Country:US
Mailing Address - Phone:615-453-6363
Mailing Address - Fax:
Practice Address - Street 1:ATHLETIC TRAINING
Practice Address - Street 2:1 CUMBERLAND SQ
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087
Practice Address - Country:US
Practice Address - Phone:615-453-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer