Individual
CARLY DION FULTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4307 1ST AVE NE, BRADENTON, FL 34208-5431
(941) 961-0645
Mailing address
4307 1ST AVE NE, BRADENTON, FL 34208-5431
(941) 961-0645
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA23455
FL
Other
Enumeration date
07/12/2013
Last updated
07/12/2013
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