Provider Demographics
NPI:1043752835
Name:FULLER, ASHLEY KAE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:KAE
Last Name:FULLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 ROBBIE VW
Mailing Address - Street 2:APT 2122
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-8227
Mailing Address - Country:US
Mailing Address - Phone:321-279-8426
Mailing Address - Fax:
Practice Address - Street 1:104 PRO RODEO DR
Practice Address - Street 2:SUITE 110
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2334
Practice Address - Country:US
Practice Address - Phone:719-592-1788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0014436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist