1811999022 NPI number — MRS. SHARON ELIZABETH WALSH-FARRELL PT

Table of content: MRS. SHARON ELIZABETH WALSH-FARRELL PT (NPI 1811999022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811999022 NPI number — MRS. SHARON ELIZABETH WALSH-FARRELL PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALSH-FARRELL
Provider First Name:
SHARON
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALSH-FARRELL
Provider Other First Name:
SHARON
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811999022
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2850 N COUNTRY CLUB RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85716-1910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-322-6274
Provider Business Mailing Address Fax Number:
520-884-0199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6264 E GRANT ROAD
Provider Second Line Business Practice Location Address:
BORDEN PHYSICAL THERAPY, LLC
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85712-5882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-884-0001
Provider Business Practice Location Address Fax Number:
520-884-0199
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  1602 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5688 . This is a "HEALTH NET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1899071 . This is a "FIRST HEALTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 86-0757479 . This is a "CHAMPUS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 0461270 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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