Individual
MARLISA FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6513 WICKLOW PL, FAYETTEVILLE, NC 28304-2773
(804) 901-1044
Mailing address
6513 WICKLOW PL, FAYETTEVILLE, NC 28304-2773
(804) 901-1044
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18709
NC
Other
Enumeration date
05/01/2023
Last updated
05/01/2023
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