Provider Demographics
NPI:1891955647
Name:FULTON, KIRSTYN HEDAHL (DPT)
Entity Type:Individual
Prefix:
First Name:KIRSTYN
Middle Name:HEDAHL
Last Name:FULTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 COMMERCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4925
Mailing Address - Country:US
Mailing Address - Phone:651-968-5675
Mailing Address - Fax:651-968-5904
Practice Address - Street 1:2090 WOODWINDS DR STE 100
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2522
Practice Address - Country:US
Practice Address - Phone:651-968-5675
Practice Address - Fax:651-968-5904
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8141225100000X
MN2421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist