Provider Demographics
NPI:1326294372
Name:FULLER, SANDRA FOGARTY (PT)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:FOGARTY
Last Name:FULLER
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 1:3000 RICHMOND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3102
Mailing Address - Country:US
Mailing Address - Phone:713-621-2486
Mailing Address - Fax:713-621-2491
Practice Address - Street 1:3000 RICHMOND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3102
Practice Address - Country:US
Practice Address - Phone:713-621-2486
Practice Address - Fax:713-621-2491
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1118313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist