Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1142024 | TX |
NPI | 1720378425 |
---|---|
Provider Name | Tonya Fuller |
First Address | Englewood, CO 80110-2132 |
Second Address | Englewood, CO 80110-2132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2011 |
Last Update Date | 10/01/2020 |