Provider Demographics
NPI:1790809176
Name:FARRELL, MAURA DOROTHY (LPTA)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:DOROTHY
Last Name:FARRELL
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 FOUNDERS CREST CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-6375
Mailing Address - Country:US
Mailing Address - Phone:804-594-7270
Mailing Address - Fax:
Practice Address - Street 1:7015 CARNATION ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-5294
Practice Address - Country:US
Practice Address - Phone:804-320-1412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306000872225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant