Provider Demographics
NPI:1356829139
Name:FULBRIGHT, VANESSA (MA, ATC, SCAT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:FULBRIGHT
Suffix:
Gender:F
Credentials:MA, ATC, SCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-3799
Mailing Address - Country:US
Mailing Address - Phone:864-488-8243
Mailing Address - Fax:
Practice Address - Street 1:1115 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-3799
Practice Address - Country:US
Practice Address - Phone:864-488-8243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer