Timothy Michael Fullmer, MSPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

022693-1 Issued in NY

Practice address

150 Broad St
Waverly, NY 14892-1361

Phone

(607) 687-2495

NPI assigned

Dec 19, 2006

Last updated

Mar 26, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Orthopedic and Sports Therapy Associates, LLP

  • Physical Therapist
  • Elmira, NY
  • NPI 1700965407
  NPD (past)

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616716800000",
    "number": "1104989268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 BROAD ST",
            "city": "WAVERLY",
            "state": "NY",
            "postal_code": "148921361",
            "telephone_number": "607-687-2495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 BROAD ST",
            "city": "WAVERLY",
            "state": "NY",
            "postal_code": "148921361",
            "telephone_number": "607-687-2495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLMER",
        "first_name": "TIMOTHY",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "MSPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2021-03-26",
        "certification_date": "2021-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "022693",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "022693-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tfullmer143205@direct-guthrie.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "150 Broad St",
            "city": "Waverly",
            "state": "NY",
            "country_code": "US",
            "postal_code": "148921361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elderwood Assisted Living at Tioga LLC
• Elderwood Health Care at Tioga LLC
• Gregory Lynn Finch, MSW
• Bernadette Frenz, LCSW
• Ashley M Fuller, SPEECH PATHOLIGIST
• Stephanie Noel Furness, OTR/L
• Guthrie Clinic LTD (Guthrie Medical Group)
• Guthrie Clinic LTD (Guthrie Medical Group)
• Guthrie Health
• Guthrie Medical Group, P.C.

• Physical Therapist in Waverly, NY
• Providers in Waverly, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2021; 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.