Provider Demographics
NPI:1528304052
Name:LYSA FARRELL PHYSICAL THERAPY INC.
Entity type:Organization
Organization Name:LYSA FARRELL PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYSA
Authorized Official - Middle Name:ZAIDE
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:630-854-3601
Mailing Address - Street 1:10S456 DUNHAM DR
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-7107
Mailing Address - Country:US
Mailing Address - Phone:630-854-3601
Mailing Address - Fax:630-985-2589
Practice Address - Street 1:10S456 DUNHAM DR
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-7107
Practice Address - Country:US
Practice Address - Phone:630-854-3601
Practice Address - Fax:630-985-2589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011650251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health