Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner | SL000835 L | PA |
NPI | 1053395087 |
---|---|
Provider Name | Terri Fulton |
First Address | Greenville, SC 29601-2629 |
Second Address | Greenville, SC 29601-2629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 20/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001862010004 | (05) | PA |
1354279 | HIGHMARK (01) | PA |
163616 | MEDPLUS (01) | PA |
2653150 | AETNA HMO (01) | PA |
7721306 | AETNA HMO (01) | PA |
819174 | FIRST PRIORITY/BC/BS (01) | PA |