Amy Z. Fullen, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

000866 Issued in WV

Practice address

RR 2 Box 169-G
Grayrock Professional Park
Lewisburg, WV 24901-9316

Phone

(304) 645-1706

Fax

(304) 645-4085

NPI assigned

Jan 8, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1043368400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 W PINHOOK RD",
            "address_2": "SUITE A",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705032131",
            "telephone_number": "337-233-1307",
            "fax_number": "337-233-5764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "RR 2 BOX 169-G",
            "address_2": "GRAYROCK PROFESSIONAL PARK",
            "city": "LEWISBURG",
            "state": "WV",
            "postal_code": "249019316",
            "telephone_number": "304-645-1706",
            "fax_number": "304-645-4085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLEN",
        "first_name": "AMY",
        "middle_name": "Z.",
        "name_prefix": "Ms.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-08",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WV",
            "license": "000866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Lewisburg, WV
• Providers in Lewisburg, WV by specialty
• Physical Therapist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.