MEDICARE: MRS. CATHERINE JOY FULLER PH.D.

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	:	1275746620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHERINE JOY FULLER PH.D.

Provider Business Mailing Address
First Line	:	1700 WEAVER DR
Second Line	:
City	:	EIGHT MILE
State	:	AL
Zip	:	36613-2820
Country	:	US
Telephone Number	:	251-679-7575
Fax Number	:

Provider Business Practice Location Address
First Line	:	3480 SPRING HILL AVE
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36608-1523
Country	:	US
Telephone Number	:	251-341-0927
Fax Number	:

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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