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NPI Code Detail

MEDICARE: MARK FULGHUM MPT

MEDICARE: MARK FULGHUM MPT
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
1225100000XPhysical TherapistPT19278FL

General Provider Information

NPI Number : 1336310770
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK FULGHUM MPT
Provider Business Mailing Address
First Line : 2615 PEAK ST
Second Line :
City : PALM HARBOR
State : FL
Zip : 34683-3151
Country : US
Telephone Number : 727-515-3206
Fax Number :
Provider Business Practice Location Address
First Line : 2960 TAMPA RD
Second Line :
City : PALM HARBOR
State : FL
Zip : 34684-3340
Country : US
Telephone Number : 727-786-4009
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2008
Last Update Date : 03/13/2008

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