Individual
BROOKE FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AT, ATC
Contact information
Practice address
18681 WINGATE RD, MANCHESTER, MI 48158-9422
(734) 646-3802
Mailing address
18681 WINGATE RD, MANCHESTER, MI 48158-9422
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000016497
MI
Other
Enumeration date
01/26/2015
Last updated
01/26/2015
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