Provider Demographics
NPI:1043791684
Name:FULGHUM, DAWN MARIA (LPTA)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:MARIA
Last Name:FULGHUM
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6804 STETTER DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-7561
Mailing Address - Country:US
Mailing Address - Phone:682-560-1923
Mailing Address - Fax:
Practice Address - Street 1:2450 BICKERS ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75212-1507
Practice Address - Country:US
Practice Address - Phone:214-879-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2003042225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant