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General NPI Number Information
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NPI Number | 1568073377
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Entity Type | Individual
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Provider Name | SELENA NICOLE FULLER DPT
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Gender | Female
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Dates
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Enumeration Date | 08/14/2020
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 1352 US HWY 2
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City | CRYSTAL FALLS
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State | MI
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Zip | 49920
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Country | US
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Telephone | 906-874-1124
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Fax | 906-874-2124
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Provider Business Mailing Address
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Address Line | 1352 US HWY 2
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City | CRYSTAL FALLS
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State | MI
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Zip | 49920
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Country | US
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Telephone | 906-874-1124
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Fax | 906-874-2124
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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 | PT018633
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 15213-24
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501019643
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License Number State | MI
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