Provider Demographics
NPI:1326700071
Name:FAUX, PEARL DAWN (LMT)
Entity Type:Individual
Prefix:
First Name:PEARL
Middle Name:DAWN
Last Name:FAUX
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 PINE ST STE G
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1658
Mailing Address - Country:US
Mailing Address - Phone:208-502-0728
Mailing Address - Fax:208-575-8309
Practice Address - Street 1:515 PINE ST STE G
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1658
Practice Address - Country:US
Practice Address - Phone:208-502-0728
Practice Address - Fax:208-575-8309
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-4547225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDMAS-4547OtherLICENSE