MEDICARE: JORDAN FULLER DPT

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	225100000X	Physical Therapist	5501019539	MI

General Provider Information

NPI Number	:	1386266211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN FULLER DPT

Provider Business Mailing Address
First Line	:	836 CAMBRIA STREET
Second Line	:
City	:	CRESSON
State	:	PA
Zip	:	16630
Country	:	US
Telephone Number	:	814-242-3796
Fax Number	:

Provider Business Practice Location Address
First Line	:	1523 US HIGHWAY 2
Second Line	:
City	:	CRYSTAL FALLS
State	:	MI
Zip	:	49920-9633
Country	:	US
Telephone Number	:	906-874-1444
Fax Number	:

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

Provider Enumeration Date	:	05/14/2020
Last Update Date	:	05/14/2020

Similar Medicare Providers

1447337068 — STEPHANIE GANSCHOW PHARMD
Practice Location Address:

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax:

1346214426 — IRON COUNTY MEDICAL CARE FACILITY
Practice Location Address:

1523 HIGHWAY US 2
CRYSTAL FALLS, MI
49920-9633

Practice Phone: 906-875-6671
Practice Fax: 906-875-6573

1174783443 — MRS. ASHLEY SUE GUZOWSKI COTA
Practice Location Address:

1523 US HIGHWAY 2
CRYSTAL FALLS, MI
49920-9633

Practice Phone: 906-874-1422
Practice Fax: 906-874-1442

1982864245 — LISA JEAN CURNOW O.T.R.
Practice Location Address:

1523 US HIGHWAY 2
CRYSTAL FALLS, MI
49920-9633

Practice Phone: 906-874-1422
Practice Fax: 906-874-1442

1336626886 — LISA ANNE CAROLLO MS,OTL
Practice Location Address:

1523 US HIGHWAY 2
CRYSTAL FALLS, MI
49920-9633

Practice Phone: 906-874-1444
Practice Fax:

1568430114 — MRS. MARIE KONOSKE R.D.H.
Practice Location Address:

211 S 4TH ST
CRYSTAL FALLS, MI
49920-1503

Practice Phone: 906-875-6133
Practice Fax:

Directions to “ JORDAN FULLER DPT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.