Individual
LISA L FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT,PCS
Contact information
Practice address
6202 CERULEAN AVE, GARDEN GROVE, CA 92845-2756
(714) 347-0300
Mailing address
6202 CERULEAN AVE, GARDEN GROVE, CA 92845-2756
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT15269
CA
2251P0200X
Pediatric Physical Therapist
Primary
PT15269
CA
Other
Enumeration date
06/13/2006
Last updated
07/11/2007
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