Provider Demographics
NPI:1558347617
Name:FULP THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:FULP THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:FULP
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:336-725-3911
Mailing Address - Street 1:2430 REYNOLDA RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4606
Mailing Address - Country:US
Mailing Address - Phone:336-725-3911
Mailing Address - Fax:336-725-3995
Practice Address - Street 1:2430 REYNOLDA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4606
Practice Address - Country:US
Practice Address - Phone:336-725-3911
Practice Address - Fax:336-725-3995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2306235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC1898OtherMEDCOST
NC013T5OtherBCBS
NC7210759Medicaid
NC7434118Medicaid
NC7411912Medicaid
NCC1899OtherMEDCOST
NC7210759Medicaid