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Individual

SHANNON FULLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RPT

Contact information

Practice address
1235 YANCEY ST, ROANOKE, AL 36274-2141
(334) 863-3535
(334) 863-7276
Mailing address
1514 OWENS ST, GADSDEN, AL 35904-4938
(256) 543-1030
(256) 439-2830

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTH7164
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
7542411
DRIVER'S LICENSE
AL
01
PTH7164
AL BOARD OF PHYSICAL THERAPY
AL
Enumeration date
06/11/2014
Last updated
06/11/2014
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