Provider Demographics
NPI:1437234358
Name:FADULLON, ROWENA IGTIBEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:ROWENA
Middle Name:IGTIBEN
Last Name:FADULLON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12105 JEREME TRL
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-8224
Mailing Address - Country:US
Mailing Address - Phone:972-335-9127
Mailing Address - Fax:
Practice Address - Street 1:12105 JEREME TRL
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-8224
Practice Address - Country:US
Practice Address - Phone:972-335-9127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13131909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist