Individual
MALLORY FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2701 CHESTNUT STATION CT, LOUISVILLE, KY 40299-6395
(800) 335-1060
Mailing address
2915 LINCOLN ST, HIGHLAND, IN 46322-2139
(219) 902-5962
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06004965A
IN
225200000X
Physical Therapy Assistant
160.006801
IL
Other
Enumeration date
03/19/2015
Last updated
03/19/2015
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