Individual
DR. BRIANNA FULLENKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
6809 N KNOXVILLE AVE, PEORIA, IL 61614-2812
(309) 981-8810
Mailing address
5716 W OVERLAND PASS, PEORIA, IL 61607-1110
(309) 678-5610
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070023007
IL
Other
Enumeration date
10/11/2018
Last updated
05/08/2019
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