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General NPI Number Information
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NPI Number | 1477593309
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Entity Type | Individual
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Provider Name | STEPHEN E FADULLON R.P.T
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Gender | Male
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3 PARKINSON RD
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-8087
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Country | US
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Telephone | 570-517-5113
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Fax |
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Provider Business Mailing Address
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Address Line | 916 SAW CREEK EST
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City | BUSHKILL
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State | PA
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Zip | 18324-9462
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Country | US
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Telephone | 570-588-4094
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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 | PT011509L
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License Number State | PA
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