Provider Demographics
NPI:1295123370
Name:FAULKNER, CAREY ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:CAREY
Middle Name:ANN
Last Name:FAULKNER
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 1:398 PROVIDENCE NEW LONDON TPKE
Mailing Address - Street 2:
Mailing Address - City:NORTH STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06359-1727
Mailing Address - Country:US
Mailing Address - Phone:860-202-7473
Mailing Address - Fax:
Practice Address - Street 1:1145 POQUONNOCK RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4620
Practice Address - Country:US
Practice Address - Phone:860-446-9960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-25
Last Update Date:2014-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006935225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist