Provider Demographics
NPI:1730176421
Name:FALCON, BEVERLY JUNE (DPT, MSA, OCS)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:JUNE
Last Name:FALCON
Suffix:
Gender:F
Credentials:DPT, MSA, OCS
Other - Prefix:MS
Other - First Name:BEVERLY
Other - Middle Name:JUNE
Other - Last Name:COKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, MSA, OCS
Mailing Address - Street 1:243 CURTISS RD
Mailing Address - Street 2:
Mailing Address - City:BARKSDALE AFB
Mailing Address - State:LA
Mailing Address - Zip Code:71110-2425
Mailing Address - Country:US
Mailing Address - Phone:318-456-6352
Mailing Address - Fax:
Practice Address - Street 1:243 CURTISS RD
Practice Address - Street 2:
Practice Address - City:BARKSDALE AFB
Practice Address - State:LA
Practice Address - Zip Code:71110-2425
Practice Address - Country:US
Practice Address - Phone:318-456-6352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVAD000Medicare UPIN