MEDICARE: MR. DUSTIN C FULLAWAY 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
1	225100000X	Physical Therapist	40QA01355900	NJ

General Provider Information

NPI Number	:	1346553807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DUSTIN C FULLAWAY PT

Provider Business Mailing Address
First Line	:	187 MILLBURN AVE
Second Line	:	STE 110
City	:	MILLBURN
State	:	NJ
Zip	:	07041-1847
Country	:	US
Telephone Number	:	973-467-7976
Fax Number	:	973-467-7971

Provider Business Practice Location Address
First Line	:	1325 WARREN AVE
Second Line	:	SUITE 5
City	:	SPRING LAKE
State	:	NJ
Zip	:	07762-2566
Country	:	US
Telephone Number	:	732-449-7855
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2010
Last Update Date	:	07/26/2010

Similar Medicare Providers

1255363255 — MR. BRIAN SCOTT SIMON PT
Practice Location Address:

1325 WARREN AVE , SUITE 5
SPRING LAKE, NJ
07762-2566

Practice Phone: 732-449-7855
Practice Fax: 732-449-7856

1942227400 — MRS. EILEEN GURGONE DPT
Practice Location Address:

1325 WARREN AVE , SUITE 5
SPRING LAKE, NJ
07762-2566

Practice Phone: 973-467-7976
Practice Fax:

1861837742 — DEREK J MC CONNELL P.T.
Practice Location Address:

1325 WARREN AVE
SPRING LAKE, NJ
07762-2566

Practice Phone: 732-449-7855
Practice Fax: 732-449-7856

1932524667 — DR. BRIAN BRATERIS DPT
Practice Location Address:

1325 WARREN AVE
SPRING LAKE, NJ
07762-2566

Practice Phone: 732-449-5394
Practice Fax: 732-449-7855

1780130567 — PROFESSIONAL ORTHOPEDIC AND SPORTS PHYSICAL THERAPY OF NJ, LLC
Practice Location Address:

1325 WARREN AVE
SPRING LAKE, NJ
07762-2566

Practice Phone: 732-449-7855
Practice Fax: 732-449-7856

1821548306 — PROFESSIONAL OCCUPATIONAL & PHYSICAL THERAPY, PLLC
Practice Location Address:

1325 WARREN AVE
SPRING LAKE, NJ
07762-2566

Practice Phone: 732-449-7855
Practice Fax: 732-449-7856

Directions to “ MR. DUSTIN C FULLAWAY PT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.