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General NPI Number Information
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NPI Number | 1336679653
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Entity Type | Individual
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Provider Name | CHELSEA JEAN FALCONER PT, DPT, ATC, CSCS
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Gender | Female
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Dates
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Enumeration Date | 06/19/2017
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | 1643 N ALPINE RD
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City | ROCKFORD
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State | IL
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Zip | 61107-1462
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Country | US
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Telephone | 815-977-4095
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Fax |
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Provider Business Mailing Address
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Address Line | 225 W PARK ST
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City | POPLAR GROVE
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State | IL
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Zip | 61065-9792
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Country | US
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Telephone | 815-713-8284
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 096003814
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070024395
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License Number State | IL
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