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Individual
JANE LESLEY FULTON
Active
Individual
JANE LESLEY FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT13250
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2989794
AETNA GROUP PROV NUMBER
—
01
—
6697189
GHI INDIV PROV NUM
FL
05
—
890851600
—
FL
01
—
Y6163
BCBS INDIV PROV NUM
FL
Enumeration date
06/13/2006
Last updated
08/18/2015
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