Provider Demographics
NPI:1851562094
Name:SANDY FULLER INC.
Entity Type:Organization
Organization Name:SANDY FULLER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:FOGARTY
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:832-368-5536
Mailing Address - Street 1:4801 WOODWAY DR
Mailing Address - Street 2:SUITE 370W
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-1884
Mailing Address - Country:US
Mailing Address - Phone:713-622-7060
Mailing Address - Fax:713-622-7093
Practice Address - Street 1:13319 MISTY MILL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-5501
Practice Address - Country:US
Practice Address - Phone:832-368-5536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-16
Last Update Date:2008-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1118313261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy