Provider Demographics
NPI:1780360362
Name:FULLER, KELSEY (PT, DPT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:VANPELT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1000 BONNIE BRAE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76111-4355
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 BONNIE BRAE AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76111-4355
Practice Address - Country:US
Practice Address - Phone:682-235-3816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist