Provider Demographics
NPI:1982135422
Name:FAULKNER, BRUCE WESLEY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:WESLEY
Last Name:FAULKNER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LENAPE RD
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-2527
Mailing Address - Country:US
Mailing Address - Phone:862-377-5137
Mailing Address - Fax:
Practice Address - Street 1:1120 PROMENADE BLVD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2770
Practice Address - Country:US
Practice Address - Phone:201-703-8820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-26
Last Update Date:2017-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA016282002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic