Provider Demographics
NPI:1548584089
Name:FARRELL, KATHLEEN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:FARRELL
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 PYTHIAN RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-6368
Mailing Address - Country:US
Mailing Address - Phone:707-539-0524
Mailing Address - Fax:
Practice Address - Street 1:350 PYTHIAN RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-6368
Practice Address - Country:US
Practice Address - Phone:707-539-0524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 10102251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics