Individual
BRENT FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
7231 SUNWOOD DR NW, RAMSEY, MN 55303-5190
(763) 236-0000
Mailing address
17740 LAYTON PATH, LAKEVILLE, MN 55044-5214
(651) 955-1424
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
06/05/2017
Last updated
03/17/2018
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