Provider Demographics
NPI:1831499367
Name:FULLER, DAVID CHRISTOPHER (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHRISTOPHER
Last Name:FULLER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-0445
Mailing Address - Country:US
Mailing Address - Phone:270-256-2932
Mailing Address - Fax:
Practice Address - Street 1:227 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:KY
Practice Address - Zip Code:42320-2131
Practice Address - Country:US
Practice Address - Phone:270-274-9221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004884225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist