Jacqueline Fullam, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT015090 Issued in PA

Practice address

2300 Pleasant Valley Rd
York, PA 17402-9627

Phone

(717) 757-3537

Fax

(717) 718-9701

NPI assigned

Oct 15, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ati Holdings, LLC

  • Physical Therapy Clinic/Center
  • Rising Sun, MD
  • NPI 1396781050

  PA, Physical Therapist

  Medicare reassignment NPD
• Ati Holdings, LLC

  • Durable Medical Equipment & Medical Supplies
  • King of Prussia, PA
  • NPI 1750194460

  Physical Therapist

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588723200000",
    "number": "1447340724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "866-370-8206",
            "fax_number": "517-435-3670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 PLEASANT VALLEY RD",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174029627",
            "telephone_number": "717-757-3537",
            "fax_number": "717-718-9701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLAM",
        "first_name": "JACQUELINE",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-15",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT015090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER",
            "identifier": "002004718",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADVANTRA",
            "identifier": "1514688",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY NATIONAL / FIRST HEALTH",
            "identifier": "1592146",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BC BS",
            "identifier": "002004718",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH AMERICA",
            "identifier": "1514688",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Fryberger
• Alan Fuhrman, RRT, RRT-ACCS
• Alyx Nicole Fuhrman, CNM
• Jill A Fuhrman, PT
• Kelli Ann Fuhrman, M.S., CCC-SLP
• Melinda S Fuller, CRNP
• Amanda Fulton
• Marshall Haven Fulton II
• Noreen E Fulton, LCSW
• Robin Lynn Funk, PMHNP BC

• Physical Therapist in York, PA
• Providers in York, PA by specialty
• Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.