Provider Demographics
NPI:1427039809
Name:FULTON, JOHN (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:FULTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DELAVERGNE AVE
Mailing Address - Street 2:C/O CENTER FOR PHYSICAL THERAPY
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-1202
Mailing Address - Country:US
Mailing Address - Phone:845-297-4789
Mailing Address - Fax:845-297-8596
Practice Address - Street 1:2 DELAVERGNE AVE
Practice Address - Street 2:C/O CENTER FOR PHYSICAL THERAPY
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-1202
Practice Address - Country:US
Practice Address - Phone:845-297-4789
Practice Address - Fax:845-297-8596
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P3106209OtherOXFORD
3102929OtherAETNA HMO
83399OtherOPERATING ENGNRS LCL 825
NYQ5081OtherBLUE CROSS BLUE SHIELD
2276723OtherUNITED HEALTH CARE
713697OtherMVP
2162486OtherCCN
7542427OtherAETNA PPO
000409357001OtherHEALTH NOW
807052OtherMANAGED PHYSICAL NETWORK
QP5961Medicare ID - Type UnspecifiedMEDICARE