Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | 40QB00103800 | NJ |
Y | 225200000X | Physical Therapy Assistant | PTA 21448 | FL |
NPI | 1013161397 |
---|---|
Provider Name | Mr. Mitchell Sean Farrell |
First Address | Valrico, FL 33596-6347 |
Second Address | Valrico, FL 33596-6347 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2008 |
Last Update Date | 12/11/2008 |