Individual
MS. CASSANDRA ANN FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
5310 SOUTH PARK DRIVE, SUITE 4, JACKSON, WY 83002
(307) 262-6372
(307) 200-6403
Mailing address
PO BOX 7811, JACKSON, WY 83002-7811
(307) 699-7667
(307) 200-6403
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1570
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT1570
WYOMING LICENSE
WY
Enumeration date
07/20/2015
Last updated
03/07/2024
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