MEDICARE: DERRIK FAUNT 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	5501019153	MI

General Provider Information

NPI Number	:	1922664341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DERRIK FAUNT DPT

Provider Business Mailing Address
First Line	:	1325 E 11 MILE RD
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-2051
Country	:	US
Telephone Number	:	313-240-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 E 11 MILE RD
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-2051
Country	:	US
Telephone Number	:	313-240-9700
Fax Number	:

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

Provider Enumeration Date	:	05/10/2019
Last Update Date	:	01/17/2023

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