Provider Demographics
NPI:1326215526
Name:FULLMER, JANET LUANN (PT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LUANN
Last Name:FULLMER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6244 N DENMARK ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-1613
Mailing Address - Country:US
Mailing Address - Phone:414-353-6589
Mailing Address - Fax:414-456-2339
Practice Address - Street 1:1126 S 70TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-3151
Practice Address - Country:US
Practice Address - Phone:414-456-2331
Practice Address - Fax:414-456-2339
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2847-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist