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NPI Code Detail

MEDICARE: MRS. ASHLEY DION FULKERSON PT

MEDICARE: MRS. ASHLEY DION FULKERSON PT
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 Therapist3362OK

General Provider Information

NPI Number : 1386664985
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ASHLEY DION FULKERSON PT
Provider Business Mailing Address
First Line : 320 N 4TH AVE
Second Line :
City : STROUD
State : OK
Zip : 74079-3641
Country : US
Telephone Number : 918-968-2656
Fax Number : 918-968-2659
Provider Business Practice Location Address
First Line : 320 N 4TH AVE
Second Line :
City : STROUD
State : OK
Zip : 74079-3641
Country : US
Telephone Number : 918-968-2656
Fax Number : 918-968-2659
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. ASHLEY DION FULKERSON PT” Practice Location

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