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General NPI Number Information
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NPI Number | 1477186534
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Entity Type | Individual
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Provider Name | PHILLIP FAUGHT ATC
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Gender | Male
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Dates
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Enumeration Date | 02/18/2020
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 802 5TH ST N
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City | CASSELTON
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State | ND
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Zip | 58012-3346
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Country | US
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Telephone | 701-347-5352
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Fax |
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Provider Business Mailing Address
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Address Line | 10 PARK ST
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City | ABSARAKA
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State | ND
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Zip | 58002-5005
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Country | US
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Telephone | 701-866-1166
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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 | 327-07
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License Number State | ND
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