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General NPI Number Information
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NPI Number | 1114790177
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Entity Type | Organization
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Legal Business Name | FULCO AND HALL PERFORMANCE AND THERAPY LLC
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Dates
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Enumeration Date | 11/01/2023
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 172 HERITAGE STE K
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City | BROUSSARD
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State | LA
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Zip | 70518-8046
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Country | US
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Telephone | 337-214-1244
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Fax | 866-825-4104
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Provider Business Mailing Address
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Address Line | 6123 KATELAND CIR
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City | BOSSIER CITY
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State | LA
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Zip | 71111-6988
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Country | US
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Telephone | 318-754-7367
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Fax | 337-247-9404
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Authorized Official
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Title or Position | OWNER, PHYSICAL THERAPIST
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Name | DR. NICHOLAS R FULCO
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Credential | PT, DPT, CERT. DN
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Telephone | 318-754-7367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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