Healthcare Provider Details

I. General information

NPI: 1881900876
Provider Name (Legal Business Name): LAURA FULTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16261 RICHMOND TPKE
BOWLING GREEN VA
22427-2203
US

IV. Provider business mailing address

17236 ANTIOCH RD
MILFORD VA
22514-2109
US

V. Phone/Fax

Practice location:
  • Phone: 804-633-5088
  • Fax:
Mailing address:
  • Phone: 858-790-1740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305208034
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: