Individual
CHAD B FULLMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.P.T.
Contact information
Practice address
5314 RIVER RUN DR, PROVO, UT 84604-5691
(801) 426-4905
Mailing address
434 E THREE FALLS DR, ALPINE, UT 84004-1296
(801) 635-6602
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4877705-2401
UT
225100000X
Physical Therapist
PT00010369
WA
Other
Enumeration date
02/26/2007
Last updated
10/29/2024
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