Brooke Fuller, AT, ATC
Individual provider Active NPI Athletic Trainer · Manchester, MI
NPI 1326438672 · NPPES record last updated Jan 26, 2015
Key facts
- NPI
- 1326438672
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 2000016497 (MI)
- Practice address
- 18681 Wingate Rd
Manchester, MI 48158-9422 - Phone
- (734) 646-3802
- NPI assigned
- Jan 26, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2000016497 | MI | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2000016497 | MI | Yes |
Addresses
Primary practice location
18681 Wingate Rd
Manchester, MI 48158-9422
Mailing address
18681 Wingate Rd
Manchester, MI 48158-9422
Other providers in Manchester, MI
- Jay Michael Demski
- Miranda Eberle
- Evelyn Eccles
- Evelyn Eccles, MD
- Claudia J Fall
- Great Lakes Bay Health Centers
- Debra Hauser
- Gary V Haynes
- Healthy Smiles Dental Care LLC
- Theresa Herron
All providers in Manchester, MI · Athletic Trainer in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.