Provider Demographics
NPI:1184822090
Name:FARRELL, LYSA Z (PT)
Entity Type:Individual
Prefix:
First Name:LYSA
Middle Name:Z
Last Name:FARRELL
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 1:10S456 DUNHAM DR
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-7107
Mailing Address - Country:US
Mailing Address - Phone:630-854-3601
Mailing Address - Fax:630-985-2589
Practice Address - Street 1:10S456 DUNHAM DR
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-7107
Practice Address - Country:US
Practice Address - Phone:630-854-3601
Practice Address - Fax:630-985-2589
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist