Provider Demographics
NPI:1053903807
Name:FARQUHAR, FROSTY RENE' (MASSAGE THERAPY)
Entity type:Individual
Prefix:
First Name:FROSTY
Middle Name:RENE'
Last Name:FARQUHAR
Suffix:
Gender:F
Credentials:MASSAGE THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1563
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78639-1563
Mailing Address - Country:US
Mailing Address - Phone:325-248-3821
Mailing Address - Fax:
Practice Address - Street 1:2415 WEST R RD 1431
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:TX
Practice Address - Zip Code:78639-7863
Practice Address - Country:US
Practice Address - Phone:325-248-3821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMI3901225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist