Alisha M Fulker, P.T., DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

10059 Issued in AZ

Practice address

1948 Mesquite Ave
Suite 101
Lake Havasu City, AZ 86403-5777

Phone

(928) 854-4776

Fax

(928) 854-4857

NPI assigned

Nov 15, 2012

Last updated

Nov 15, 2012By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352937600000",
    "number": "1871837815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1948 MESQUITE AVE",
            "address_2": "SUITE 101",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035777",
            "telephone_number": "928-854-4776",
            "fax_number": "928-854-4857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1948 MESQUITE AVE",
            "address_2": "SUITE 101",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035777",
            "telephone_number": "928-854-4776",
            "fax_number": "928-854-4857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULKER",
        "first_name": "ALISHA",
        "middle_name": "M",
        "credential": "P.T., DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-15",
        "last_updated": "2012-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "10059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.