Provider Demographics
NPI:1952585127
Name:FULLERTON, CHERIE
Entity Type:Individual
Prefix:MRS
First Name:CHERIE
Middle Name:
Last Name:FULLERTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5924
Mailing Address - Country:US
Mailing Address - Phone:304-238-0043
Mailing Address - Fax:
Practice Address - Street 1:1201 PLEASANT AVENUE
Practice Address - Street 2:BROOKE COUNTY BOARD OF EDUCATION
Practice Address - City:WELLSBURG
Practice Address - State:WV
Practice Address - Zip Code:26070-1344
Practice Address - Country:US
Practice Address - Phone:304-737-3480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist