Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | AT2368 | CA |
NPI | 1023027372 |
---|---|
Provider Name | Mrs. Lynette Kay Colyer Fultz |
First Address | Fullerton, CA 92833-3601 |
Second Address | Santa Ana, CA 92704-5331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 08/07/2007 |