Individual
MR. BRYAN CARROLL FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
612 RIO RD W STE 5, CHARLOTTESVILLE, VA 22901-1412
(434) 529-8882
(434) 529-8882
Mailing address
612 RIO RD W STE 5, CHARLOTTESVILLE, VA 22901-1412
(434) 529-8882
(434) 529-8942
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
1298
DE
224P00000X
Prosthetist
1298
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215362850
—
VA
Enumeration date
09/12/2013
Last updated
07/21/2022
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