| Doctor Name: | CHAD B FULLMER |
| NPI Number: | 1285760033 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.P.T. |
| License Number: | PT00010369 |
| Business Practice Address: | 5314 River Run Dr Provo, UT - 846045691 |
| Business Phone Number: | 8014264905 |
| Business Fax Number: | |
| Mailing Address: | 1215 W 2420 N, PLEASANT GROVE |
| State: | UT |
| Postal Code: | 840628083 |
| Phone Number: | 8016356602 |
| Fax Number: | |
| NPI Enumeration Date: | 02/26/2007 |
| NPI Last Update Date: | 07/15/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT00010369 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| 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 |