Provider Demographics
NPI:1912492422
Name:FULLEN, BILL JOE II (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:JOE
Last Name:FULLEN
Suffix:II
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BILLY
Other - Middle Name:JOE
Other - Last Name:FULLEN
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2405 N COLUMBUS ST STE 120
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8189
Mailing Address - Country:US
Mailing Address - Phone:740-687-3346
Mailing Address - Fax:740-689-9736
Practice Address - Street 1:2405 N COLUMBUS ST STE 120
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8189
Practice Address - Country:US
Practice Address - Phone:740-687-3346
Practice Address - Fax:740-689-9736
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT296443225100000X
OHPT0175292251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic