Healthcare Provider Details

I. General information

NPI: 1700650066
Provider Name (Legal Business Name): THOMAS SEAN O'FARRELL PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 WILLIAMSON RD STE A
MOORESVILLE NC
28117-6967
US

IV. Provider business mailing address

287 WILLIAMSON RD STE A
MOORESVILLE NC
28117-6967
US

V. Phone/Fax

Practice location:
  • Phone: 704-360-5511
  • Fax: 704-360-5513
Mailing address:
  • Phone: 704-360-5511
  • Fax: 704-360-5513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP22759
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: