Provider Demographics
NPI:1295374502
Name:FAISON, JAMES DONALD (PTA, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DONALD
Last Name:FAISON
Suffix:
Gender:M
Credentials:PTA, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 DESERT CIR APT 4
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3243
Mailing Address - Country:US
Mailing Address - Phone:510-292-8200
Mailing Address - Fax:
Practice Address - Street 1:1959 DESERT CIR APT 4
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3243
Practice Address - Country:US
Practice Address - Phone:510-292-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10180225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant