Provider Demographics
NPI:1649492455
Name:FARRELL, CHRISTINE A (PT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:FARRELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:ABDULKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:120 DARWIN DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226
Mailing Address - Country:US
Mailing Address - Phone:607-351-2498
Mailing Address - Fax:
Practice Address - Street 1:300 S COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187
Practice Address - Country:US
Practice Address - Phone:630-547-8045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0284821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK37374Medicare PIN