Provider Demographics
NPI:1528259611
Name:FAULKENBERRY, MARLA LITTLE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:LITTLE
Last Name:FAULKENBERRY
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:787 BEATEN PATH RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8984
Mailing Address - Country:US
Mailing Address - Phone:704-799-6542
Mailing Address - Fax:
Practice Address - Street 1:108 GATEWAY BLVD
Practice Address - Street 2:SUITE 211-B
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5596
Practice Address - Country:US
Practice Address - Phone:704-662-0386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC548225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant