Provider Demographics
NPI:1154542041
Name:FAULKNER, CAMILLA REGINA (MPT)
Entity type:Individual
Prefix:MRS
First Name:CAMILLA
Middle Name:REGINA
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 20TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-1318
Mailing Address - Country:US
Mailing Address - Phone:202-529-1284
Mailing Address - Fax:
Practice Address - Street 1:2408 20TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1318
Practice Address - Country:US
Practice Address - Phone:202-529-1284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT3075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist