Provider Demographics
NPI:1346421187
Name:FARRELL, GERALD JAMES (LMP CR)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:JAMES
Last Name:FARRELL
Suffix:
Gender:M
Credentials:LMP CR
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:FARRELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP CR
Mailing Address - Street 1:909 HARRIS AVE
Mailing Address - Street 2:SUITE 201C
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7080
Mailing Address - Country:US
Mailing Address - Phone:360-201-5808
Mailing Address - Fax:
Practice Address - Street 1:909 HARRIS AVE
Practice Address - Street 2:SUITE 201C
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7080
Practice Address - Country:US
Practice Address - Phone:360-201-5808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013595225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist