Provider Demographics
NPI:1053536185
Name:FARRELL, LISA RENEE (PT, PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:RENEE
Last Name:FARRELL
Suffix:
Gender:F
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5076 WATERS EDGE WAY
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-2621
Mailing Address - Country:US
Mailing Address - Phone:954-680-0747
Mailing Address - Fax:
Practice Address - Street 1:5200 S UNIVERSITY DR
Practice Address - Street 2:SUITE 105
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-5316
Practice Address - Country:US
Practice Address - Phone:954-382-4343
Practice Address - Fax:954-382-4342
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0005601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist