Provider Demographics
NPI:1730140369
Name:FALLON, CURTIS JOHN JR (LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:JOHN
Last Name:FALLON
Suffix:JR
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4828 CORONADO DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-8910
Mailing Address - Country:US
Mailing Address - Phone:910-792-0548
Mailing Address - Fax:
Practice Address - Street 1:555 HALEYBURTON MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-3094
Practice Address - Country:US
Practice Address - Phone:910-790-2360
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer