Individual
ANTOINEKE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
100 RORER ST, CHATHAM, VA 24531-5455
(434) 432-0471
Mailing address
3501 OLD MINE RD, GRETNA, VA 24557-2676
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306602722
VA
Other
Enumeration date
08/18/2014
Last updated
08/18/2014
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