Organization
FULLER'S ORTHOPEDIC
Active
Organization
FULLER'S ORTHOPEDIC
Active
Other names
Independence Prosthetics-Orthotics, Fuller Life Orthotics and Prosthetics
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRYAN CARROLL FULLER CPO (OWNER)
(434) 529-8882
Entity
Organization
Contact information
Practice address
612 RIO RD W STE 5, CHARLOTTESVILLE, VA 22901-1412
(434) 529-8882
(434) 529-8882
Mailing address
612 RIO RD W STE 5, CHARLOTTESVILLE, VA 22901-1412
(434) 529-8882
(434) 529-8942
Taxonomy
Speciality
Code
Description
License number
State
261QA0900X
Amputee Clinic/Center
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
09/13/2013
Last updated
10/17/2023
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