| Doctor Name: | MR. DUSTIN C FULLAWAY |
| NPI Number: | 1346553807 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | 40QA01355900 |
| Business Practice Address: | 1325 Warren Ave Suite 5 Spring Lake, NJ - 077622566 |
| Business Phone Number: | 7324497855 |
| Business Fax Number: | |
| Mailing Address: | 187 Millburn Ave, Ste 110 MILLBURN |
| State: | NJ |
| Postal Code: | 070411847 |
| Phone Number: | 9734677976 |
| Fax Number: | 9734677971 |
| NPI Enumeration Date: | 07/26/2010 |
| NPI Last Update Date: | 07/26/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 40QA01355900 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| 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 |