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General NPI Number Information
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NPI Number | 1245658574
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Entity Type | Organization
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Legal Business Name | LORRAINE M FARRELL PT MED PLLC
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Dates
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Enumeration Date | 04/03/2014
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Last Update Date | 04/03/2014
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Provider Practice Location Address
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Address Line | 267 EXECUTIVE DRIVE
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City | SHELBURNE
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State | VT
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Zip | 05482
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Country | US
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Telephone | 802-324-8455
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 802
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City | SHELBURNE
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State | VT
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Zip | 05482-0802
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | LORRAINE FARRELL
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Credential |
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Telephone | 802-324-8455
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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 | 040.0002393
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License Number State | VT
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