Tyeisha Fuller, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PTH12093 Issued in AL

Practice address

564 N Memorial Dr
Prattville, AL 36067-2132

Phone

(334) 491-0066

NPI assigned

Nov 12, 2024

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

Enrolled in AL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Stonestar Health LLC

  • Clinic/Center
  • Montgomery, AL
  • NPI 1669175600
  Medicare reassignment
• The Bailey Center, LLC

  • Speech-Language Pathologist
  • Prattville, AL
  • NPI 1306477328
  NPD

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

{
    "created_epoch": "1731369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1376367888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "834 LEGENDS DR",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361166576",
            "telephone_number": "574-370-4564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "564 N MEMORIAL DR",
            "city": "PRATTVILLE",
            "state": "AL",
            "postal_code": "360672132",
            "telephone_number": "334-491-0066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "TYEISHA",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-12",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AL",
            "license": "PTH12093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fountain City Eyecare LLC
• Fountain City Speech Therapy, LLC
• Steven Jay Frawley, RPH
• Lucius Bedford Freeman, MD
• Teran Renee Fulford, SPEECH THERAPIST
• Rachiel Gamble
• Silvia E Garcia-Lavin, DPM
• Ebony Janae Gardner-Ellis
• Julie Annette Garten, LICSW
• GD Al Glynwood PLLC

• Physical Therapist in Prattville, AL
• Providers in Prattville, AL by specialty
• Physical Therapist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.