Provider Demographics
NPI:1710067293
Name:FERRELL, PATRICIA GRACE (PT)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:GRACE
Last Name:FERRELL
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 1:80525 DUNBAR DR
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-8928
Mailing Address - Country:US
Mailing Address - Phone:760-200-4381
Mailing Address - Fax:760-200-3215
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:RINKER BLDG
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-766-2572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7720171WH0202X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171WH0202XOther Service ProvidersContractorHome Modifications
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT77200Medicare PIN