Healthcare Provider Details

I. General information

NPI: 1477535516
Provider Name (Legal Business Name): WILLIAM HENRY FARNELL PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7965 MOFFETT RD
SEMMES AL
36575-5409
US

IV. Provider business mailing address

2048A S BROAD ST BROOKLEY COMPLEX
MOBILE AL
36615-1285
US

V. Phone/Fax

Practice location:
  • Phone: 251-645-3708
  • Fax: 251-645-5837
Mailing address:
  • Phone: 251-433-1414
  • Fax: 251-433-9634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH4083
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: