Provider Demographics
NPI:1255850095
Name:FULLER, PAIGE MARY (DPT)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:MARY
Last Name:FULLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 RIMMEY RD
Mailing Address - Street 2:
Mailing Address - City:CENTRE HALL
Mailing Address - State:PA
Mailing Address - Zip Code:16828-9217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:224 RIMMEY RD
Practice Address - Street 2:
Practice Address - City:CENTRE HALL
Practice Address - State:PA
Practice Address - Zip Code:16828-9217
Practice Address - Country:US
Practice Address - Phone:814-360-2397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PANMedicaid