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NPI Code Detail

MEDICARE: MRS. DAWN MARIA FULGHUM LPTA

MEDICARE: MRS. DAWN MARIA FULGHUM LPTA
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
1225200000XPhysical Therapy Assistant2003042TX

General Provider Information

NPI Number : 1043791684
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DAWN MARIA FULGHUM LPTA
Provider Business Mailing Address
First Line : 6804 STETTER DR
Second Line :
City : ARLINGTON
State : TX
Zip : 76001-7561
Country : US
Telephone Number : 682-560-1923
Fax Number :
Provider Business Practice Location Address
First Line : 2450 BICKERS ST
Second Line :
City : DALLAS
State : TX
Zip : 75212-1507
Country : US
Telephone Number : 214-879-0888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2018
Last Update Date : 08/22/2018

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