Provider Demographics
NPI:1275826943
Name:FAULKNER, JANINE MARIE
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:MARIE
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11929 CEDAR GULLY RD
Mailing Address - Street 2:
Mailing Address - City:BEACH CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77523-8272
Mailing Address - Country:US
Mailing Address - Phone:281-975-9961
Mailing Address - Fax:
Practice Address - Street 1:11929 CEDAR GULLY RD
Practice Address - Street 2:
Practice Address - City:BEACH CITY
Practice Address - State:TX
Practice Address - Zip Code:77523-8272
Practice Address - Country:US
Practice Address - Phone:281-975-9961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2019719225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant