JORDAN LOUIS FULLER

WALTHAM, MA
NPI1992214803
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225100000X Physical Therapist
(Licence: MA  26548)
Additional Taxonomies2081S0010X Physical Medicine & Rehabilitation, Sports Medicine
(Licence: MA  3209)
Enumeration Date2017-09-22
Last Update Date2022-11-10
Business Address
JORDAN LOUIS FULLER PT, DPT, LAT, ATC
840 WINTER ST
WALTHAM, MA 02451-1433
Phone number: 781-487-9944
Mailing Address
JORDAN LOUIS FULLER PT, DPT, LAT, ATC
50 OCEAN AVE APT 513A
REVERE, MA 02151-3897
Phone number: 916-337-4524