Individual
STEVE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1014 BURRELL AVE, LEWISTON, ID 83501-5589
(208) 743-4558
(208) 746-7657
Mailing address
25117 SW PARKWAY AVE STE D, WILSONVILLE, OR 97070-9697
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-2424
ID
Other
Enumeration date
04/29/2014
Last updated
04/29/2014
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