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General NPI Number Information
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NPI Number | 1710492970
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Entity Type | Individual
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Provider Name | MARY KATHEEN FALCONER
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Gender | Female
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Dates
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Enumeration Date | 12/11/2017
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Last Update Date | 12/11/2017
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Provider Practice Location Address
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Address Line | 240 SPRUCE ST
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City | GRIDLEY
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State | CA
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Zip | 95948-2216
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Country | US
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Telephone | 877-366-2580
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Fax |
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Provider Business Mailing Address
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Address Line | 5625 GRAND VIEW CT
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City | ROCKLIN
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State | CA
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Zip | 95765-5010
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Country | US
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Telephone | 916-737-6034
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State | CA
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