Provider Demographics
NPI:1477670545
Name:FAUST, DONALD (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:FAUST
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3970 OAKS CLUBHOUSE DR
Mailing Address - Street 2:#301
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-3672
Mailing Address - Country:US
Mailing Address - Phone:954-956-9683
Mailing Address - Fax:
Practice Address - Street 1:3970 OAKS CLUBHOUSE DR
Practice Address - Street 2:#301
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3672
Practice Address - Country:US
Practice Address - Phone:954-956-9683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer