Provider Demographics
NPI:1194746743
Name:FARRELL, MARNY TERESE (MPT)
Entity type:Individual
Prefix:
First Name:MARNY
Middle Name:TERESE
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 JACKSON ST
Mailing Address - Street 2:MAIL STOP 11102D
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2502
Mailing Address - Country:US
Mailing Address - Phone:651-254-2032
Mailing Address - Fax:651-254-0910
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:MAIL STOP 11102D
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-2032
Practice Address - Fax:651-254-0910
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8229OtherPHYSICAL THERAPY LICENSE
MN8229OtherPHYSICAL THERAPY LICENSE