Individual
MS. SHANNON RAE FARRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
7440 N SHADELAND AVE, 130, INDIANAPOLIS, IN 46250-2029
(317) 577-7333
(317) 577-7330
Mailing address
7440 N SHADELAND AVE, 130, INDIANAPOLIS, IN 46250-2029
(317) 577-7333
(317) 577-7330
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05002490A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05002490A
PROFESSIONAL LINCENSE
IN
Enumeration date
04/02/2008
Last updated
04/02/2008
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