Provider Demographics
NPI:1083647572
Name:FULBRIGHT, DENISE H
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:H
Last Name:FULBRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-0369
Mailing Address - Country:US
Mailing Address - Phone:864-201-4301
Mailing Address - Fax:678-840-2112
Practice Address - Street 1:132 GRUBER RD
Practice Address - Street 2:
Practice Address - City:CROSS HILL
Practice Address - State:SC
Practice Address - Zip Code:29332-4818
Practice Address - Country:US
Practice Address - Phone:864-201-4301
Practice Address - Fax:678-840-2112
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist