Provider Demographics
NPI:1477593309
Name:FADULLON, STEPHEN E (RPT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:FADULLON
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 SAW CREEK EST
Mailing Address - Street 2:
Mailing Address - City:BUSHKILL
Mailing Address - State:PA
Mailing Address - Zip Code:18324-9462
Mailing Address - Country:US
Mailing Address - Phone:570-588-4094
Mailing Address - Fax:
Practice Address - Street 1:3 PARKINSON RD
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8087
Practice Address - Country:US
Practice Address - Phone:570-517-5113
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011509L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist