Provider Demographics
NPI:1750893418
Name:FULTON, SEAN (PTA)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:FULTON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 EVANS ST
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-1407
Mailing Address - Country:US
Mailing Address - Phone:412-610-0754
Mailing Address - Fax:412-967-9910
Practice Address - Street 1:1339 FREEPORT RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-3126
Practice Address - Country:US
Practice Address - Phone:412-967-9229
Practice Address - Fax:412-967-9910
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE011569225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant