Provider Demographics
NPI:1386664985
Name:FULKERSON, ASHLEY DION (PT)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:DION
Last Name:FULKERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:DION
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:320 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:STROUD
Mailing Address - State:OK
Mailing Address - Zip Code:74079-3641
Mailing Address - Country:US
Mailing Address - Phone:918-968-2656
Mailing Address - Fax:918-968-2659
Practice Address - Street 1:320 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:STROUD
Practice Address - State:OK
Practice Address - Zip Code:74079-3641
Practice Address - Country:US
Practice Address - Phone:918-968-2656
Practice Address - Fax:918-968-2659
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist