Provider Demographics
NPI:1548531791
Name:FOULKE, KRISTOPHER WR (MED, ATC)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:WR
Last Name:FOULKE
Suffix:
Gender:M
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 E BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-2312
Mailing Address - Country:US
Mailing Address - Phone:215-206-8981
Mailing Address - Fax:
Practice Address - Street 1:182 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:PA
Practice Address - Zip Code:18938-1392
Practice Address - Country:US
Practice Address - Phone:215-862-2028
Practice Address - Fax:215-862-3198
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0038282255A2300X
DEJ3-00003542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer