Provider Demographics
NPI:1639318850
Name:FULKS, ERICA R (PT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:R
Last Name:FULKS
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 1:2829 BABCOCK ROAD
Mailing Address - Street 2:SUITE 710
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6015
Mailing Address - Country:US
Mailing Address - Phone:210-804-5400
Mailing Address - Fax:210-678-4142
Practice Address - Street 1:2829 BABCOCK ROAD
Practice Address - Street 2:SUITE 710
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6015
Practice Address - Country:US
Practice Address - Phone:210-804-5400
Practice Address - Fax:210-678-4142
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1181849225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1181849OtherPT LICENSE