Provider Demographics
NPI:1891053971
Name:FULTZ, YOLANDA (CPO, LPO)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:FULTZ
Suffix:
Gender:F
Credentials:CPO, LPO
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:
Other - Last Name:BIDDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPO, LPO
Mailing Address - Street 1:11155 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-5600
Mailing Address - Country:US
Mailing Address - Phone:713-474-4171
Mailing Address - Fax:713-747-4249
Practice Address - Street 1:11155 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5600
Practice Address - Country:US
Practice Address - Phone:713-474-4171
Practice Address - Fax:713-747-4249
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist