Provider Demographics
NPI:1184442659
Name:FARRELL, BENJAMIN LUKE (PT, DPT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LUKE
Last Name:FARRELL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3514 JEFFERSON ST APT 401
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-4822
Mailing Address - Country:US
Mailing Address - Phone:479-466-9679
Mailing Address - Fax:
Practice Address - Street 1:7410 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-1966
Practice Address - Country:US
Practice Address - Phone:913-379-9771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-07672225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist