Healthcare Provider Details

I. General information

NPI: 1235377011
Provider Name (Legal Business Name): KATIE E FULTON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 11/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 COMMERCE WAY SUITE 101
DOVER DE
19904-7794
US

IV. Provider business mailing address

200 CLEAVER FARM RD SUITE 400
MIDDLETOWN DE
19709-1630
US

V. Phone/Fax

Practice location:
  • Phone: 304-724-6344
  • Fax: 302-449-2047
Mailing address:
  • Phone: 302-449-2048
  • Fax: 302-449-2047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: