Provider Demographics
NPI:1477535516
Name:FARNELL, WILLIAM HENRY (PT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HENRY
Last Name:FARNELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2048A S BROAD ST
Mailing Address - Street 2:BROOKLEY COMPLEX
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36615-1285
Mailing Address - Country:US
Mailing Address - Phone:251-433-1414
Mailing Address - Fax:251-433-9634
Practice Address - Street 1:7965 MOFFETT RD
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575-5409
Practice Address - Country:US
Practice Address - Phone:251-645-3708
Practice Address - Fax:251-645-5837
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-24718OtherBC/BS PROV #-BROOKLEY
AL051524913OtherBCBS FOR SEMMES LOCATION
AL051524913Medicare PIN
AL051524913OtherBCBS FOR SEMMES LOCATION
AL515-24718OtherBC/BS PROV #-BROOKLEY
AL510I650231Medicare PIN