Provider Demographics
NPI:1154841971
Name:FULLER, BRITTNEY NICOLE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:NICOLE
Last Name:FULLER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10114 PINTAIL PL APT 202
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1940
Mailing Address - Country:US
Mailing Address - Phone:919-616-8272
Mailing Address - Fax:
Practice Address - Street 1:900 CENTER PARK DR STE J
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-2962
Practice Address - Country:US
Practice Address - Phone:919-616-8272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-31312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer