MEDICARE: DR. BARBARA L FALLON MSPT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305202857	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	194317	OTHER	VA	ANTHEM BCBS
2	G350-0001	OTHER	DC	CAREFIRST BCBS

General Provider Information

NPI Number	:	1750585410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA L FALLON MSPT, DPT

Provider Business Mailing Address
First Line	:	4635 KNIGHT PL
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22311-4923
Country	:	US
Telephone Number	:	703-845-7947
Fax Number	:	703-527-5624

Provider Business Practice Location Address
First Line	:	801 N QUINCY ST
Second Line	:	SUITE #130
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1999
Country	:	US
Telephone Number	:	703-527-5492
Fax Number	:	703-527-5624

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	07/08/2007

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