Individual
TYEISHA FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
564 N MEMORIAL DR, PRATTVILLE, AL 36067-2132
(334) 491-0066
Mailing address
834 LEGENDS DR, MONTGOMERY, AL 36116-6576
(574) 370-4564
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTH12093
AL
Other
Enumeration date
11/12/2024
Last updated
11/12/2024
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