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General NPI Number Information
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NPI Number | 1639719388
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Entity Type | Organization
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Legal Business Name | FULLER BALANCE THERAPY AND EDUCATION
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Dates
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Enumeration Date | 01/10/2020
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 750 W HAMPDEN AVE STE 425
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City | ENGLEWOOD
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State | CO
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Zip | 80110-2099
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Country | US
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Telephone | 720-647-3456
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Fax | 720-647-3466
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Provider Business Mailing Address
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Address Line | 750 W HAMPDEN AVE STE 425
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City | ENGLEWOOD
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State | CO
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Zip | 80110-2099
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TONYA FULLER
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Credential |
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Telephone | 720-647-3456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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