MEDICARE: DARYL FAULKNER M.S., ATC, LAT

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	2255A2300X	Athletic Trainer	AT8280	TX

General Provider Information

NPI Number	:	1841644861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARYL FAULKNER M.S., ATC, LAT

Provider Business Mailing Address
First Line	:	8515 BRODIE LN APT 227
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-8096
Country	:	US
Telephone Number	:	901-409-2814
Fax Number	:

Provider Business Practice Location Address
First Line	:	2012 ROBERT DEDMAN DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78712-1754
Country	:	US
Telephone Number	:	901-409-2814
Fax Number	:

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

Provider Enumeration Date	:	04/15/2016
Last Update Date	:	05/01/2024

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