Individual
JORDAN FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1523 US HIGHWAY 2, CRYSTAL FALLS, MI 49920-9633
(906) 874-1444
Mailing address
836 CAMBRIA STREET, CRESSON, PA 16630
(814) 242-3796
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501019539
MI
Other
Enumeration date
05/14/2020
Last updated
05/14/2020
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