Provider Demographics
NPI:1942408711
Name:FARRELL, PAIGE RENE' (PT)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:RENE'
Last Name:FARRELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:RENE'
Other - Last Name:FARRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, MSPT
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:9768 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:PAINTED POST
Practice Address - State:NY
Practice Address - Zip Code:14870-9094
Practice Address - Country:US
Practice Address - Phone:607-937-4854
Practice Address - Fax:607-937-4888
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH010874225100000X
TX1195733225100000X
NY0385512251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist