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Individual

DR. CARISSA ANNE FULLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT, DPT

Contact information

Practice address
1175 NININGER RD, HASTINGS, MN 55033-1056
(651) 480-4100
Mailing address
11053 287TH AVE NW, ZIMMERMAN, MN 55398-4344
(612) 220-6509

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12043
MN

Other

Enumeration date
05/11/2022
Last updated
05/11/2022
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