Provider Demographics
NPI:1669455309
Name:TODD FARRELL
Entity Type:Organization
Organization Name:TODD FARRELL
Other - Org Name:MUSCULAR THERAPY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-353-9155
Mailing Address - Street 1:3208 BENNER PIKE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-8475
Mailing Address - Country:US
Mailing Address - Phone:814-353-9155
Mailing Address - Fax:
Practice Address - Street 1:3208 BENNER PIKE
Practice Address - Street 2:SUITE 130
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-8475
Practice Address - Country:US
Practice Address - Phone:814-353-9155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMU1747553OtherHIGHMARK BLUE SHIELD
PA50026720OtherCAPITAL BLUECROSS
PA237909OtherHEALTHAMERICA/HEALTHASSUR
PA50026720OtherCAPITAL BLUECROSS