Provider Demographics
NPI:1679075584
Name:GAINES- FARHI, ADIA ATIRA, ATHURA (LMT)
Entity type:Individual
Prefix:
First Name:ADIA
Middle Name:ATIRA, ATHURA
Last Name:GAINES- FARHI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 OCEAN AVE APT 31
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-1346
Mailing Address - Country:US
Mailing Address - Phone:646-575-0189
Mailing Address - Fax:
Practice Address - Street 1:54 W 14TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7501
Practice Address - Country:US
Practice Address - Phone:646-575-0189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027855-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist