Provider Demographics
NPI:1477186534
Name:FAUGHT, PHILLIP (ATC)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:
Last Name:FAUGHT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PARK ST
Mailing Address - Street 2:
Mailing Address - City:ABSARAKA
Mailing Address - State:ND
Mailing Address - Zip Code:58002-5005
Mailing Address - Country:US
Mailing Address - Phone:701-866-1166
Mailing Address - Fax:
Practice Address - Street 1:802 5TH ST N
Practice Address - Street 2:
Practice Address - City:CASSELTON
Practice Address - State:ND
Practice Address - Zip Code:58012-3346
Practice Address - Country:US
Practice Address - Phone:701-347-5352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND327-072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer