Provider Demographics
NPI:1740610708
Name:FALLON, ALEXANDER (DPT)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:FALLON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 HARTFORD TPKE
Mailing Address - Street 2:SUITE U
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4852
Mailing Address - Country:US
Mailing Address - Phone:860-979-1611
Mailing Address - Fax:860-875-0804
Practice Address - Street 1:9B FIELDSTONE CMNS
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3421
Practice Address - Country:US
Practice Address - Phone:860-870-9800
Practice Address - Fax:860-870-9806
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009969225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist