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Individual

LAUREL ALLISON FULLERTON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
P.T.

Contact information

Practice address
770 W RESERVE DR, KALISPELL, MT 59901-2130
(406) 253-3276
(406) 755-3992
Mailing address
770 W RESERVE DR, KALISPELL, MT 59901-2130
(406) 253-3276
(406) 755-3992

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
740
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
346-788
MT
Enumeration date
07/10/2006
Last updated
07/21/2022
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