Individual
LORI JO FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
214 LOUISIANA AVE, PERRYSBURG, OH 43551-1459
(419) 873-7653
Mailing address
214 LOUISIANA AVE, PERRYSBURG, OH 43551-1459
(419) 873-7653
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
33.010516
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33.010516
MASSAGE LICENSE
OH
Enumeration date
05/14/2020
Last updated
05/14/2020
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