Doctor Name: | NICOLE M. FULLAWAY |
NPI Number: | 1235442690 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DPT |
License Number: | 40QA01356100 |
Business Practice Address: | 1104 Arnold Ave Point Pleasant Boro, NJ - 087422311 |
Business Phone Number: | 7327140070 |
Business Fax Number: | |
Mailing Address: | 41 Adamston Dr, BRICK |
State: | NJ |
Postal Code: | 087238004 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 07/14/2010 |
NPI Last Update Date: | 08/30/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251X0800X |
License Number: | 40QA01356100 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Orthopedic |
Taxonomy Definition: |