Individual
CARLY FULLERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSS ATC
Contact information
Practice address
201 HIGH ST, FARMVILLE, VA 23909-1800
(434) 395-2965
Mailing address
713 MONROE ST, FARMVILLE, VA 23901-3137
(703) 407-8076
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126001340
VA
Other
Enumeration date
07/28/2014
Last updated
04/13/2018
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