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NPI Code Detail

MEDICARE: JENNIFER ELIZABETH FULLER PT

MEDICARE: JENNIFER ELIZABETH FULLER PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT60044173WA
2225100000XPhysical Therapist296647CA

General Provider Information

NPI Number : 1265668446
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER ELIZABETH FULLER PT
Provider Business Mailing Address
First Line : 1600 MAIN ST FL 2
Second Line :
City : VENICE
State : CA
Zip : 90291-3626
Country : US
Telephone Number : 888-859-0145
Fax Number : 888-858-1601
Provider Business Practice Location Address
First Line : 6080 CENTER DR.
Second Line : 6TH FLOOR SUITE # 639
City : LOS ANGELES
State : CA
Zip : 90045-9205
Country : US
Telephone Number : 888-859-0145
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2009
Last Update Date : 10/14/2022

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