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General NPI Number Information
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NPI Number | 1396624219
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Entity Type | Individual
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Provider Name | KELLY ANNE FAULK PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 08/27/2025
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 6200 S MCCLINTOCK DR STE 115
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City | TEMPE
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State | AZ
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Zip | 85283-3449
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Country | US
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Telephone | 480-730-0501
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 N HAYDEN RD APT 3046
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City | SCOTTSDALE
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State | AZ
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Zip | 85257-1756
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Country | US
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Telephone | 919-352-8544
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | LPT-034324
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License Number State | AZ
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