# FULLINGTON PHYSICAL THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881402683
- **Authorized official:** RYAN M FULLINGTON DPT (OWNER)
- **Authorized official phone:** (262) 364-9221

## Contact information

- **Practice address:** 8500 MARYLAND AVE APT 513, SAINT LOUIS, MO 63124-2318
- **Practice address phone:** (262) 364-9221
- **Mailing address:** 8500 MARYLAND AVE APT 513, SAINT LOUIS, MO 63124-2318

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/26/2024
- **Last updated:** 12/26/2024