Healthcare Provider Details

I. General information

NPI: 1528304052
Provider Name (Legal Business Name): LYSA FARRELL PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10S456 DUNHAM DR
DOWNERS GROVE IL
60516-7107
US

IV. Provider business mailing address

10S456 DUNHAM DR
DOWNERS GROVE IL
60516-7107
US

V. Phone/Fax

Practice location:
  • Phone: 630-854-3601
  • Fax: 630-985-2589
Mailing address:
  • Phone: 630-854-3601
  • Fax: 630-985-2589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number070011650
License Number StateIL

VIII. Authorized Official

Name: MRS. LYSA ZAIDE FARRELL
Title or Position: OWNER
Credential: PT
Phone: 630-854-3601