MEDICARE: DAVID M FARRELL PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1103380	TX

General Provider Information

NPI Number	:	1033104096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID M FARRELL PT

Provider Business Mailing Address
First Line	:	6169 KARI DR
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-7063
Country	:	US
Telephone Number	:	321-255-7255
Fax Number	:

Provider Business Practice Location Address
First Line	:	1381 S PATRICK DR
Second Line	:
City	:	PATRICK AFB
State	:	FL
Zip	:	32925-3606
Country	:	US
Telephone Number	:	321-494-8129
Fax Number	:	321-494-1378

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	07/08/2007

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Directions to “ DAVID M FARRELL PT” Practice Location

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