Individual
MARY R FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
300 W HOSPITAL RD, SINTERDISCIPLINARY PAIN MANAGEMENT CENTER, FORT GORDON, GA 30905-5741
(706) 787-1473
Mailing address
300 W HOSPITAL RD, SINTERDISCIPLINARY PAIN MANAGEMENT CENTER, FORT GORDON, GA 30905-5741
(706) 787-1473
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
558
MS
Other
Enumeration date
11/16/2009
Last updated
07/24/2015
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