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General NPI Number Information
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NPI Number | 1053536185
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Entity Type | Individual
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Provider Name | LISA RENEE FARRELL P.T., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 07/20/2007
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Provider Practice Location Address
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Address Line | 5200 S UNIVERSITY DR SUITE 105
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City | DAVIE
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State | FL
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Zip | 33328-5316
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Country | US
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Telephone | 954-382-4343
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Fax | 954-382-4342
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Provider Business Mailing Address
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Address Line | 5076 WATERS EDGE WAY
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City | COOPER CITY
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State | FL
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Zip | 33330-2621
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Country | US
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Telephone | 954-680-0747
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0005601
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License Number State | FL
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