Provider Demographics
NPI:1841698974
Name:FULSHER, LAUREN (DPT)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:FULSHER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:B
Other - Last Name:YEOMANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:29255 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1018
Mailing Address - Country:US
Mailing Address - Phone:248-353-1234
Mailing Address - Fax:
Practice Address - Street 1:4600 INVESTMENT DR STE 190
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-6365
Practice Address - Country:US
Practice Address - Phone:248-353-1234
Practice Address - Fax:248-480-2059
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist