Individual
JEFFREY FALIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
32 GUDGER RD, SEWANEE, TN 37375-2896
(863) 381-2410
Mailing address
32 GUDGER RD, SEWANEE, TN 37375-2896
(863) 381-2410
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1879
TN
2255A2300X
Athletic Trainer
AL3900
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1879
LAT TN
TN
01
—
2000016578
BOC
—
01
—
62983
NATA
—
01
—
AL 3900
LAT FL
FL
Enumeration date
08/04/2015
Last updated
08/04/2015
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