MEDICARE: GREGORY FULTON LMP

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
1	225700000X	Massage Therapist	MA60415553	WA

General Provider Information

NPI Number	:	1821499781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY FULTON LMP

Provider Business Mailing Address
First Line	:	13301 28TH AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-4324
Country	:	US
Telephone Number	:	206-931-3675
Fax Number	:

Provider Business Practice Location Address
First Line	:	918 S HORTON ST
Second Line	:	UNIT 915
City	:	SEATTLE
State	:	WA
Zip	:	98134-1952
Country	:	US
Telephone Number	:	206-931-3675
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2014
Last Update Date	:	09/10/2014

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Directions to “ GREGORY FULTON LMP” Practice Location

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