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Jerry Wallace Fulford
Massage Therapist in Capitola, California
NPI 1427547355

Jerry Wallace Fulford is a Massage Therapist based in Capitola, CA. Jerry Wallace Fulford practices in Capitola, CA. The NPI Number for Jerry Wallace Fulford is 1427547355 and holds a License No. 75622 (California).

The current practice location address for Jerry Wallace Fulford is 4170 Gross Rd. Extension, Capitola, CA and can be reached out via phone at 831-464-1605.

Location: 4170 Gross Rd. Extension, Capitola, CA, 95010
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1427547355
Provider Name
Jerry Wallace Fulford
Credential
Provider Entity Type
Individual
Gender
Male
Address
4170 Gross Rd. Extension, Capitola, CA, 95010
Phone Number
831-464-1605
Fax Number
Provider Enumeration Date
05/07/2018
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
4170 Gross Rd. Extension
City
Capitola
State
California
Zip
95010
Phone Number
831-464-1605
Fax Number
person
Provider Business Mailing Address Details
Address
4170 Gross Rd. Extension
City
Capitola
State
California
Zip
95010
Phone Number
831-464-1605
Fax Number
person
Provider's Taxonomy Details 1
Type
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Classification
Massage Therapist
Speciality
-
Taxonomy
225700000X
License No.
75622 (California)
Definition
An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes.
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