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General NPI Number Information
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NPI Number | 1164294948
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Entity Type | Organization
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Legal Business Name | FULLER'S ORTHOPEDIC
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Dates
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Enumeration Date | 10/25/2023
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 36 PARKWAY LN STE 122
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City | FISHERSVILLE
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State | VA
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Zip | 22939-2430
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Country | US
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Telephone | 540-917-0006
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Fax | 540-917-0506
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Provider Business Mailing Address
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Address Line | 36 PARKWAY LN STE 122
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City | FISHERSVILLE
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State | VA
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Zip | 22939-2430
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Country | US
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Telephone | 540-917-0006
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Fax | 540-917-0506
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Authorized Official
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Title or Position | MANAGER
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Name | BRYAN CARROLL FULLER
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Credential | CPO
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Telephone | 434-529-8882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number |
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License Number State |
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