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Individual
JEREMY RYAN FAUST
Active
Individual
JEREMY RYAN FAUST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICAL THERAPIST
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT28673
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ15795Z
MEDICARE GROUP PTAN - VALLEJO
CA
01
—
ZZZ25256Z
MEDICARE GROUP PTAN - BENICIA
CA
Enumeration date
11/21/2005
Last updated
05/29/2008
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