Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT2727 | MS |
NPI | 1003116062 |
---|---|
Provider Name | James O Farrell JR. |
First Address | Flowood, MS 39232-6633 |
Second Address | Flowood, MS 39232-6633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2010 |
Last Update Date | 23/10/2020 |