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General NPI Number Information
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NPI Number | 1376459891
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Entity Type | Individual
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Provider Name | JACKSON MORAHAN FARRELL DPT
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Gender | Male
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Dates
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Enumeration Date | 08/24/2026
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Last Update Date | 08/24/2026
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Provider Practice Location Address
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Address Line | 2707 W JEFFERSON AVE
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City | TRENTON
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State | MI
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Zip | 48183-2804
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Country | US
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Telephone | 734-692-5903
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Fax |
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Provider Business Mailing Address
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Address Line | 21092 THOROFARE RD
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City | GROSSE ILE
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State | MI
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Zip | 48138-1231
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Country | US
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Telephone | 734-692-5903
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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 | 5501304715
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License Number State | MI
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