Provider Demographics
NPI:1992839021
Name:FULTON, STEPHEN M (PT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:FULTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1882 GLEN HILL HWY
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MI
Mailing Address - Zip Code:49235-9685
Mailing Address - Country:US
Mailing Address - Phone:517-547-3814
Mailing Address - Fax:
Practice Address - Street 1:202 S LANE ST
Practice Address - Street 2:
Practice Address - City:BLISSFIELD
Practice Address - State:MI
Practice Address - Zip Code:49228-1243
Practice Address - Country:US
Practice Address - Phone:517-486-5278
Practice Address - Fax:517-486-5298
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist