MEDICARE: ANDRE ESSON FAULK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	0015782	CO

General Provider Information

NPI Number	:	1093685828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRE ESSON FAULK

Provider Business Mailing Address
First Line	:	3208 SPRINGMEADOW CIR
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80109-7956
Country	:	US
Telephone Number	:	337-308-2701
Fax Number	:

Provider Business Practice Location Address
First Line	:	3911 AMBROSIA ST STE 102
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80109-3887
Country	:	US
Telephone Number	:	303-870-8242
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2025
Last Update Date	:	11/06/2025

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Directions to “ ANDRE ESSON FAULK ” Practice Location

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