Provider Demographics
NPI:1902171507
Name:FULFORD, PAULA ELIZABETH (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:ELIZABETH
Last Name:FULFORD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:LIBBY
Other - Middle Name:
Other - Last Name:FULFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:111 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-2011
Mailing Address - Country:US
Mailing Address - Phone:252-641-7776
Mailing Address - Fax:
Practice Address - Street 1:111 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-2011
Practice Address - Country:US
Practice Address - Phone:252-641-7385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist