NPIMap

Organization Active NPI

Fuller Physical Therapy

  • Physical Therapist
  • Beaver Dam, KY
National Provider Identifier
1477857423
Registry record updated Jul 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
FULLER PHYSICAL THERAPY
Practice address
227 S Main St
Beaver Dam, KY 42320-2131
Phone
(270) 274-9221
Fax
(270) 955-2003
NPI assigned
Jan 5, 2011
Last updated
Jul 28, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2020

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

Authorized official

Name
Dr. David Christopher Fuller, PT,DPTNPI 1831499367
Title
Owner and Physical Therapist
Phone
(270) 256-2932

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary
Occupational Therapist 225X00000X NU

Addresses

Primary practice location

227 S Main St
Beaver Dam, KY 42320-2131

Mailing address

PO Box 445
Hartford, KY 42347-0445
Phone (270) 274-9221

Other identifiers 1

IdentifierTypeStateIssuer
7100316910MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140113001544 KY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6507054889 Receives reassigned benefits from 13 practitioners
Practice locations: Beaver Dam, KY; Leitchfield, KY; Morgantown, KY; Princeton, KY

National Provider Directory

National Provider Directory

Locations

227 S Main St
Beaver Dam, KY 42320
Phone (270) 274-9221

113 Ashley Plaza Cir
Morgantown, KY 42261
Phone (270) 288-5105

1102 Triplett St
Ste 1001
Owensboro, KY 42303
Phone (270) 240-1415

2072 US Highway 62 W
Princeton, KY 42445
Phone (270) 365-5226

123 E Main St
Providence, KY 42450
Phone (270) 515-8080

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1294185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595894400000",
    "number": "1477857423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 445",
            "city": "HARTFORD",
            "state": "KY",
            "postal_code": "423470445",
            "telephone_number": "270-274-9221",
            "fax_number": "270-955-2003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "227 S MAIN ST",
            "city": "BEAVER DAM",
            "state": "KY",
            "postal_code": "423202131",
            "telephone_number": "270-274-9221",
            "fax_number": "270-955-2003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLER PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-05",
        "last_updated": "2020-07-28",
        "certification_date": "2020-07-28",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "OWNER AND PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "270-256-2932",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT,DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100316910",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaver Dam, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2020; 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.