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Individual
MRS. TEIA SQUIRES FULLER
Active
Individual
MRS. TEIA SQUIRES FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
5293
SC
225100000X
Physical Therapist
Primary
8082
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3650210
—
TN
01
—
4214519
BLUE CROSS BLUE SHIELD OF TN
TN
01
—
CH4394
MEDICARE RAILROAD GROUP
TN
Enumeration date
11/01/2006
Last updated
06/24/2010
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