Provider Demographics
NPI:1649800574
Name:FALES, NANCY JEAN (PT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:JEAN
Last Name:FALES
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 1:6385 E 22 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SAND LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49343-8985
Mailing Address - Country:US
Mailing Address - Phone:616-826-0668
Mailing Address - Fax:
Practice Address - Street 1:6385 E 22 MILE RD
Practice Address - Street 2:
Practice Address - City:SAND LAKE
Practice Address - State:MI
Practice Address - Zip Code:49343-8985
Practice Address - Country:US
Practice Address - Phone:616-826-0668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist