Individual
MR. DUSTIN C FULLAWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1325 WARREN AVE, SUITE 5, SPRING LAKE, NJ 07762-2566
(732) 449-7855
Mailing address
187 MILLBURN AVE, STE 110, MILLBURN, NJ 07041-1847
(973) 467-7976
(973) 467-7971
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40QA01355900
NJ
Other
Enumeration date
07/26/2010
Last updated
07/26/2010
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