Provider Demographics
NPI:1609021294
Name:GEORGE, FALLON SHALEE (DPT)
Entity type:Individual
Prefix:DR
First Name:FALLON
Middle Name:SHALEE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:FALLON
Other - Middle Name:SHALEE
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2950 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4421
Mailing Address - Country:US
Mailing Address - Phone:917-592-2459
Mailing Address - Fax:
Practice Address - Street 1:2950 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4421
Practice Address - Country:US
Practice Address - Phone:917-592-2459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030034-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist