Healthcare Provider Details

I. General information

NPI: 1356250138
Provider Name (Legal Business Name): ABIGAIL LYNNE FARRELL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TRIANGLE SHOPPING CTR
LONGVIEW WA
98632-4673
US

IV. Provider business mailing address

1104 SMOKEWOOD DR
APEX NC
27502-6419
US

V. Phone/Fax

Practice location:
  • Phone: 360-501-3750
  • Fax:
Mailing address:
  • Phone: 919-455-0855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.PT.70174223-CP
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP25189
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: