Individual
SHANNON FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPT
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
Update your record
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