MEDICARE: JEFFREY FAULRING

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	PT023542	PA
2	2251X0800X	Orthopedic Physical Therapist

General Provider Information

NPI Number	:	1790196939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY FAULRING

Provider Business Mailing Address
First Line	:	475 ALLENDALE RD STE 206
Second Line	:
City	:	KING OF PRUSSIA
State	:	PA
Zip	:	19406-1495
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 E LANCASTER AVE STE 205
Second Line	:
City	:	ARDMORE
State	:	PA
Zip	:	19003-3209
Country	:	US
Telephone Number	:	484-297-6491
Fax Number	:

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

Provider Enumeration Date	:	05/09/2014
Last Update Date	:	06/03/2019

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Directions to “ JEFFREY FAULRING ” Practice Location

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