Provider Demographics
NPI:1689793986
Name:FULLER, CATHERINE LEIGH (MPT)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:LEIGH
Last Name:FULLER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6206 GUTHRIE CT
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6641
Mailing Address - Country:US
Mailing Address - Phone:410-781-0423
Mailing Address - Fax:
Practice Address - Street 1:10632 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 129, 2000 BUILDING
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3273
Practice Address - Country:US
Practice Address - Phone:410-740-0300
Practice Address - Fax:410-740-0302
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist