MEDICARE: AIMEE MARIE FULLERTON

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	5501016266	MI

General Provider Information

NPI Number	:	1376035162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIMEE MARIE FULLERTON

Provider Business Mailing Address
First Line	:	6551 PARK OF COMMERCE BLVD
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33487-8218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 W GENESEE ST
Second Line	:
City	:	FRANKENMUTH
State	:	MI
Zip	:	48734-1316
Country	:	US
Telephone Number	:	800-513-5641
Fax Number	:

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

Provider Enumeration Date	:	06/06/2018
Last Update Date	:	06/06/2018

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Directions to “ AIMEE MARIE FULLERTON ” Practice Location

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