MEDICARE: MISS HELEN MELISSA FULLER M.A., RKT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	226300000X	Kinesiotherapist

General Provider Information

NPI Number	:	1003872839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS HELEN MELISSA FULLER M.A., RKT

Provider Business Mailing Address
First Line	:	118 COLLEGE DRIVE #5142
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39406-0001
Country	:	US
Telephone Number	:	601-266-5365
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 COLLEGE DRIVE #5142
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39406-0001
Country	:	US
Telephone Number	:	601-266-5365
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	07/08/2007

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