| Doctor Name: | RANDELLE K FULLER |
| NPI Number: | 1023237120 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MPT |
| License Number: | PT00010472 |
| Business Practice Address: | 965 Goethals Dr Richland, WA - 993523527 |
| Business Phone Number: | 5094605588 |
| Business Fax Number: | 5097835438 |
| Mailing Address: | 6703 W Rio Grande Ave, KENNEWICK |
| State: | WA |
| Postal Code: | 993362623 |
| Phone Number: | 5094605588 |
| Fax Number: | 5097835438 |
| NPI Enumeration Date: | 04/25/2007 |
| NPI Last Update Date: | 02/23/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT00010472 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |