Provider Demographics
NPI:1710674544
Name:FARRELL, TESSA BRYN (PTA)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:BRYN
Last Name:FARRELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:BRYN
Other - Last Name:WHITEHEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:23930 ROBBINS RD
Mailing Address - Street 2:
Mailing Address - City:ASTATULA
Mailing Address - State:FL
Mailing Address - Zip Code:34705-9698
Mailing Address - Country:US
Mailing Address - Phone:352-459-8575
Mailing Address - Fax:
Practice Address - Street 1:437 W ARDICE AVENUE
Practice Address - Street 2:SUITE 481
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726
Practice Address - Country:US
Practice Address - Phone:352-505-1415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA29570225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant