Provider Demographics
NPI:1558366252
Name:FULTON, DENE M (PT)
Entity Type:Individual
Prefix:MRS
First Name:DENE
Middle Name:M
Last Name:FULTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 JACKSON AVE W
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5416
Mailing Address - Country:US
Mailing Address - Phone:662-234-8559
Mailing Address - Fax:662-234-7923
Practice Address - Street 1:2304 JACKSON AVE W
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5416
Practice Address - Country:US
Practice Address - Phone:662-234-8559
Practice Address - Fax:662-234-7923
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1476225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS650021550OtherMEDICARE RAILROAD
MS09727885Medicaid
MS09727885Medicaid