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NPI Code Detail

MEDICARE: MR. DONALD M FULLER M.P.T.

MEDICARE: MR. DONALD M FULLER M.P.T.
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
1225100000XPhysical Therapist
2225100000XPhysical TherapistPT014020LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2001939987OTHERBC/BS

General Provider Information

NPI Number : 1417985540
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DONALD M FULLER M.P.T.
Provider Business Mailing Address
First Line : 1337 W. 6 ST.
Second Line :
City : ERIE
State : PA
Zip : 16505-2503
Country : US
Telephone Number : 814-456-6000
Fax Number : 814-456-6060
Provider Business Practice Location Address
First Line : 6419 CAROLINA BEACH RD STE C
Second Line :
City : WILMINGTON
State : NC
Zip : 28412-3672
Country : US
Telephone Number : 910-332-3828
Fax Number : 910-251-0421
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2006
Last Update Date : 02/28/2019

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