Provider Demographics
NPI:1730285263
Name:FULGHUM, ERIN M (PT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:FULGHUM
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 1:8620 E 34TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2601
Mailing Address - Country:US
Mailing Address - Phone:316-630-0700
Mailing Address - Fax:316-630-0703
Practice Address - Street 1:8620 E 34TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2601
Practice Address - Country:US
Practice Address - Phone:316-630-0700
Practice Address - Fax:316-630-0703
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-3536208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSPENDINGMedicare ID - Type Unspecified