Individual
DEBRA D FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3801 SANTA ROSA, KINGMAN, AZ 86401-2311
(928) 263-5000
Mailing address
7802 E CONCHO DR, KINGMAN, AZ 86401-8130
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
8956A
AZ
Other
Enumeration date
05/19/2011
Last updated
05/19/2011
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