Individual
HEIDI LYNN FULLERTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSPT
Contact information
Practice address
899 CECIL AVE S, MILLERSVILLE, MD 21108-2111
(410) 987-1644
Mailing address
1 WOODMAN ST, GLOUCESTER, MA 01930-2021
(617) 699-2016
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
22562
MD
Other
Enumeration date
06/02/2008
Last updated
07/29/2008
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