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NPI Code Detail

MEDICARE: JANNA RACHEL FULKERSON PT, DPT

MEDICARE: JANNA RACHEL FULKERSON PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist070029644IL

General Provider Information

NPI Number : 1952266926
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANNA RACHEL FULKERSON PT, DPT
Provider Business Mailing Address
First Line : 1501 MCPHERSON AVE
Second Line :
City : MOUNT VERNON
State : IL
Zip : 62864-2831
Country : US
Telephone Number : 618-899-1621
Fax Number :
Provider Business Practice Location Address
First Line : 1501 MCPHERSON AVE
Second Line :
City : MOUNT VERNON
State : IL
Zip : 62864-2831
Country : US
Telephone Number : 618-899-1621
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2025
Last Update Date : 12/22/2025

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