Active NPI
Stephanie Fullerton, DPT
- Physical Therapist
- Lakeland, FL
National Provider Identifier
1619440468
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 28728
- Practice address
- 3900 S Florida Ave
Lakeland, FL 33813-1151 - Phone
- (863) 647-3665
- NPI assigned
- Jan 4, 2019
- Last updated
- Jan 4, 2019
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 28728 | FL | Primary |
Addresses
Primary practice location
3900 S Florida Ave
Lakeland, FL 33813-1151
Mailing address
866 Vino Verde Cir
Brandon, FL 33511-6196
Phone (352) 205-0502
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 |
|---|---|---|---|
| 28728 | FL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rehabclinics SPT Inc | Physical Therapist | Past | Accepting new patients |
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1546560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1546560000000",
"number": "1619440468",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "866 VINO VERDE CIR",
"city": "BRANDON",
"state": "FL",
"postal_code": "335116196",
"telephone_number": "352-205-0502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3900 S FLORIDA AVE",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338131151",
"telephone_number": "863-647-3665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLERTON",
"first_name": "STEPHANIE",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-04",
"last_updated": "2019-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "28728",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakeland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.