| NPI | 1578130126 |
|---|---|
| Former Name | MADELEINE FULLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 5990) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251G0304X Physical Therapist Geriatrics (Licence: OK 5990) | |
| Enumeration Date | 2021-06-10 |
| Last Update Date | 2025-08-01 |