Chad B Fullmer, M.P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4877705-2401 Issued in UT

Practice address

5314 River Run Dr
Provo, UT 84604-5691

Phone

(801) 426-4905

NPI assigned

Feb 26, 2007

Sex

Male

Sole proprietor

No

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

• Independence Rehab, LLC

  • Physical Therapist
  • Provo, UT
  • NPI 1063781813
  Medicare reassignment Care Compare group NPD Authorized official
• Independence Rehab

  • Physical Therapist
  • Salt Lake City, UT
  • NPI 1407982630
  NPD (past) Authorized official
• Beaver Valley Hospital

  • Skilled Nursing Facility
  • West Valley City, UT
  • NPI 1942650148
  NPD (past)
• Cascades at Desert View, LLC

  • Skilled Nursing Facility
  • Buhl, ID
  • NPI 1093422370
  NPD (past)
• Cascades at Lincoln County, LLC

  • Skilled Nursing Facility
  • Shoshone, ID
  • NPI 1871200154
  NPD (past)
• Liberty County Hospital District No 1

  • Rural Health Clinic/Center
  • Liberty, TX
  • NPI 1386401560
  NPD (past)

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Beaver Valley Hospital

  • Skilled Nursing Facility
  • Blanding, UT
  • NPI 1144528290

  Adp of the SNF, Corporate Director, Operational/Managerial Control

  CMS ownership
• Beaver Valley Hospital

  • Skilled Nursing Facility
  • Price, UT
  • NPI 1154629350

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Beaver Valley Hospital

  • Skilled Nursing Facility
  • Midvale, UT
  • NPI 1215344163

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Beaver Valley Hospital

  • Skilled Nursing Facility
  • Sandy, UT
  • NPI 1548568744

  Adp of the SNF, Corporate Director, Operational/Managerial Control

  CMS ownership
• Beaver Valley Hospital

  • Skilled Nursing Facility
  • Salt Lake City, UT
  • NPI 1598990699

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Beaver Valley Hospital

  • Skilled Nursing Facility
  • South Ogden, UT
  • NPI 1861878266

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Beaver Valley Hospital

  • Skilled Nursing Facility
  • Salt Lake City, UT
  • NPI 1902130222

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Beaver Valley Hospital

  • Skilled Nursing Facility
  • St. George, UT
  • NPI 1932407137

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Cascades at Desert View, LLC

  • Skilled Nursing Facility
  • Buhl, ID
  • NPI 1093422370

  Corporate Director, Operational/Managerial Control

  CMS ownership
• Cascades at Jacinto Rehab, LP

  • Skilled Nursing Facility
  • Houston, TX
  • NPI 1104408301

  Corporate Director, Operational/Managerial Control

  CMS ownership
• Cascades at Lincoln County, LLC

  • Skilled Nursing Facility
  • Shoshone, ID
  • NPI 1871200154

  Corporate Director, Operational/Managerial Control

  CMS ownership
• Cascades at Thornton Creek LLC

  • Skilled Nursing Facility
  • Seattle, WA
  • NPI 1366275067

  Corporate Director

  CMS ownership

Specialty

Physical Therapist in Private Practice

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Independence Rehab LLC 25 clinicians

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 29, 2024.

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1285760033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "434 E THREE FALLS DR",
            "city": "ALPINE",
            "state": "UT",
            "postal_code": "840041296",
            "telephone_number": "801-635-6602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5314 RIVER RUN DR",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846045691",
            "telephone_number": "801-426-4905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLMER",
        "first_name": "CHAD",
        "middle_name": "B",
        "credential": "M.P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-26",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00010369",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "4877705-2401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arianna Alicia Fuller
• Joshua Darrell Fuller, M.D.
• Katherine H Fuller, RN
• Sarah Stolworthy Fuller, ATC
• Ken Fullerton
• Jessica Fullmer, MD
• Lisa H Fullmer, RN
• Mark Allen Fullmer, M.D.
• Amanda Funes
• Dan Furr

• All providers in Provo, UT
• Physical Therapist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.