| NPI | 1912492422 |
|---|---|
| Other Name | BILLY JOE FULLEN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT017529) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT296443) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: OH PT017529) | |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2020-02-10 |