Individual
MR. PATRICK M FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
113 SPRING ST # 1, FAYETTEVILLE, NY 13066-2021
(315) 380-0556
Mailing address
113 SPRING ST # 1, FAYETTEVILLE, NY 13066-2021
(315) 380-0556
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
27-019443
NY
Other
Enumeration date
10/22/2009
Last updated
10/19/2011
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