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General NPI Number Information
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NPI Number | 1801671037
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Entity Type | Individual
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Provider Name | EMILY ADELE FULKERSON PTA
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Gender | Female
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Dates
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Enumeration Date | 08/28/2023
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 2525 BARDSTOWN RD STE 108
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City | LOUISVILLE
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State | KY
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Zip | 40205-2680
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Country | US
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Telephone | 502-537-6166
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Fax | 502-537-6167
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Provider Business Mailing Address
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Address Line | 1705 FLAGSTAFF CT
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City | LOUISVILLE
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State | KY
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Zip | 40223-1151
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Country | US
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Telephone | 502-649-4110
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A04414
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License Number State | KY
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