Active NPI
Edsel Fullon, PT
- Contractor
- Longwood, FL
National Provider Identifier
1578006409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- PT 25414
- Practice address
- 207 Overstreet Ave
Longwood, FL 32750-5428 - Phone
- (321) 295-7678
- Fax
- (321) 295-7678
- NPI assigned
- Nov 26, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | PT 25414 | FL | Primary |
Addresses
Primary practice location
207 Overstreet Ave
Longwood, FL 32750-5428
Mailing address
207 Overstreet Ave
Longwood, FL 32750-5428
Phone (321) 295-7678
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 25414 | FL | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1480118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1480118400000",
"number": "1578006409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "207 OVERSTREET AVE",
"city": "LONGWOOD",
"state": "FL",
"postal_code": "327505428",
"telephone_number": "321-295-7678",
"fax_number": "321-295-7678"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "207 OVERSTREET AVE",
"city": "LONGWOOD",
"state": "FL",
"postal_code": "327505428",
"telephone_number": "321-295-7678",
"fax_number": "321-295-7678"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLON",
"first_name": "EDSEL",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-11-26",
"last_updated": "2016-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "FL",
"license": "PT 25414",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longwood, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.