Individual
LINDSEY MARIE FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
10603 WILD FLOWER PL, FORT WAYNE, IN 46845-1687
(260) 705-7098
Mailing address
10603 WILD FLOWER PL, FORT WAYNE, IN 46845-1687
(260) 705-7098
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
06005064A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06005064A
PHYSICAL THERAPY COMMITTEE
IN
Enumeration date
09/15/2015
Last updated
04/23/2017
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