Fulco and Hall Performance and Therapy LLC
Organization Active NPI Physical Therapist · Broussard, LA
NPI 1114790177 · NPPES record last updated Oct 29, 2024
Key facts
- NPI
- 1114790177
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- FULCO AND HALL PERFORMANCE AND THERAPY LLC
- Practice address
- 172 Heritage Ste K
Broussard, LA 70518-8046 - Phone
- (337) 214-1244
- Fax
- (866) 825-4104
- NPI assigned
- Nov 1, 2023
- Organization subpart
- No
Authorized official
- Name
- Dr. Nicholas R Fulco, PT, DPT, CERT. DN
- Title
- Owner, Physical Therapist
- Phone
- (318) 754-7367
Practitioners 2
-
Nicholas R Fulco, DPT
-
David Andrew Hall, PT, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240611001111 | LA | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 7315489960 |
Receives reassigned benefits from 2 practitioners Practice locations: Bossier City, LA |
National Provider Directory
Locations
1156 Airline Dr
Bossier City, LA 71112
Phone (318) 200-0386
172 Heritage
Ste K
Broussard, LA 70518
Phone (337) 214-1244
502 Anderson Ave
Shreveport, LA 71104
Phone (318) 200-0386
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes |
Addresses
Primary practice location
172 Heritage Ste K
Broussard, LA 70518-8046
Mailing address
6123 Kateland Cir
Bossier City, LA 71111-6988
Phone (318) 754-7367
Other practice location 1
502 Anderson Ave
Shreveport, LA 71104-3602
Phone (318) 200-0386
Other names
- FHPT
Other providers in Broussard, LA
- Jeffrey Douglas Fontenot
- Madelaine Fahrmann Fontenot
- Beneth Marie Frame
- Candace Frazier
- James Friloux Jr.
- Functional Living Solutions, LLC
- Shelly Galland
- Brigitte Luquette Girouard
- Chelsea Caillier Girouard
- Amainte B Godeaux
All providers in Broussard, LA · Physical Therapist in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.