Provider Demographics
NPI:1225647753
Name:FALK, ELIZABETH K (PTA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:FALK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 E FERN AVE APT 109
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6071
Mailing Address - Country:US
Mailing Address - Phone:131-458-3453
Mailing Address - Fax:
Practice Address - Street 1:254 E FERN AVE APT 109
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-6071
Practice Address - Country:US
Practice Address - Phone:131-458-3453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTA48409225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty