MEDICARE: DR. MARK ALLEN FAULKNER DPT

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	225100000X	Physical Therapist	2305203459	VA

General Provider Information

NPI Number	:	1689735490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ALLEN FAULKNER DPT

Provider Business Mailing Address
First Line	:	5106 BROMLEY LN
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-1535
Country	:	US
Telephone Number	:	804-363-9903
Fax Number	:

Provider Business Practice Location Address
First Line	:	1311 PALMYRA AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-4418
Country	:	US
Telephone Number	:	804-358-1412
Fax Number	:

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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