Provider Demographics
NPI:1699055533
Name:FALGOUT, NANCIE JOHNSON (PTA)
Entity type:Individual
Prefix:MRS
First Name:NANCIE
Middle Name:JOHNSON
Last Name:FALGOUT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 BROADWAY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-4432
Mailing Address - Country:US
Mailing Address - Phone:210-654-3008
Mailing Address - Fax:
Practice Address - Street 1:10200 BROADWAY ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-4432
Practice Address - Country:US
Practice Address - Phone:210-654-3008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2007787225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant