Individual
DOUGLAS DALE FULLMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
8105 124TH ST E, PUYALLUP, WA 98373-4933
(775) 296-1996
Mailing address
8105 124TH ST E, PUYALLUP, WA 98373-4933
(775) 296-1996
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
61491282
WA
Other
Enumeration date
12/06/2023
Last updated
12/06/2023
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