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General NPI Number Information
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NPI Number | 1851562094
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Entity Type | Organization
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Legal Business Name | SANDY FULLER INC.
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Dates
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Enumeration Date | 03/16/2008
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Last Update Date | 03/16/2008
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Provider Practice Location Address
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Address Line | 13319 MISTY MILL DR
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City | HOUSTON
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State | TX
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Zip | 77041-5501
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Country | US
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Telephone | 832-368-5536
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Fax |
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Provider Business Mailing Address
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Address Line | 4801 WOODWAY DR SUITE 370W
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City | HOUSTON
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State | TX
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Zip | 77056-1884
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Country | US
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Telephone | 713-622-7060
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Fax | 713-622-7093
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SANDRA FOGARTY FULLER
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Credential | P.T.
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Telephone | 832-368-5536
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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 | 1118313
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License Number State | TX
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