Provider Demographics
NPI:1164729604
Name:FAUGHT, JOLENE L (PT)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:L
Last Name:FAUGHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JOLENE
Other - Middle Name:L
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3700 SYMI CIR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4309
Mailing Address - Country:US
Mailing Address - Phone:252-247-2738
Mailing Address - Fax:252-240-3882
Practice Address - Street 1:1910 N CHURCH ST
Practice Address - Street 2:STE D
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5632
Practice Address - Country:US
Practice Address - Phone:336-274-7480
Practice Address - Fax:336-274-8903
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP12969225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist