Provider Demographics
NPI:1962385245
Name:FULTINEER, TAYLOR C
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:C
Last Name:FULTINEER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 FRIDAY RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32352-6740
Mailing Address - Country:US
Mailing Address - Phone:850-509-5031
Mailing Address - Fax:
Practice Address - Street 1:610 N CALHOUN ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-1724
Practice Address - Country:US
Practice Address - Phone:850-509-5031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA107505225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist