Healthcare Provider Details

I. General information

NPI: 1396265096
Provider Name (Legal Business Name): MICHAEL FALK PT, DPT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 GENESEE ST
DELAFIELD WI
53018-1814
US

IV. Provider business mailing address

105 1ST AVE N
MINNEAPOLIS MN
55401-1674
US

V. Phone/Fax

Practice location:
  • Phone: 623-379-3312
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number14121
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2950
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1351
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10724
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: