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General NPI Number Information
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NPI Number | 1346056595
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Entity Type | Individual
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Provider Name | HAYDEN REESE FULLER
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Gender | Male
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 8110 W UNION HILLS DR STE 320
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City | GLENDALE
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State | AZ
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Zip | 85308-8181
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Country | US
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Telephone | 623-248-8830
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Fax | 623-248-8772
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Provider Business Mailing Address
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Address Line | 8110 W UNION HILLS DR STE 320
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City | GLENDALE
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State | AZ
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Zip | 85308-8181
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Country | US
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Telephone | 623-248-8830
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Fax | 623-248-8772
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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