Provider Demographics
NPI:1457929218
Name:FARRELL, CATHERINE MARY (PTA)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:MARY
Last Name:FARRELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:
Other - Last Name:MALAPANIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 BLACKSTONE CT
Mailing Address - Street 2:
Mailing Address - City:LE CLAIRE
Mailing Address - State:IA
Mailing Address - Zip Code:52753-2300
Mailing Address - Country:US
Mailing Address - Phone:508-423-0252
Mailing Address - Fax:
Practice Address - Street 1:555 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6138
Practice Address - Country:US
Practice Address - Phone:309-764-9675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.009099225200000X
IA106291225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant