Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1239789 | TX |
NPI | 1093128829 |
---|---|
Provider Name | Mrs. Christina Nicole Fauber |
First Address | Garland, TX 75041-5823 |
Second Address | Garland, TX 75041-5823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2014 |
Last Update Date | 10/06/2014 |