Provider Demographics
NPI:1235214180
Name:FAULK, JEFFREY JAMES JR (PT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:JAMES
Last Name:FAULK
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:889 SHERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-4183
Mailing Address - Country:US
Mailing Address - Phone:704-881-0088
Mailing Address - Fax:704-881-0087
Practice Address - Street 1:889 SHERWOOD LN
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-4183
Practice Address - Country:US
Practice Address - Phone:704-881-0088
Practice Address - Fax:704-881-0087
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC43632251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7207891Medicaid
NC7207891Medicaid