Provider Demographics
NPI:1457597965
Name:FARELL, DEENA JOYCE (PHYSICAL THERAPY)
Entity Type:Individual
Prefix:MRS
First Name:DEENA
Middle Name:JOYCE
Last Name:FARELL
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31116 CHERRY DR
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-2574
Mailing Address - Country:US
Mailing Address - Phone:661-295-9683
Mailing Address - Fax:661-295-9683
Practice Address - Street 1:31116 CHERRY DR
Practice Address - Street 2:
Practice Address - City:CASTAIC
Practice Address - State:CA
Practice Address - Zip Code:91384-2574
Practice Address - Country:US
Practice Address - Phone:661-295-9683
Practice Address - Fax:661-295-9683
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 6094174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist