Active NPI
Hailey Rene Fuller, PTA
- Physical Therapy Assistant
- Amarillo, TX
National Provider Identifier
1558659789
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2067687
- Practice address
- 1250 Wallace Blvd
Amarillo, TX 79106-1741 - Phone
- (806) 353-3596
- NPI assigned
- Jul 21, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2067687 | TX | Primary |
Addresses
Primary practice location
1250 Wallace Blvd
Amarillo, TX 79106-1741
Mailing address
1716 S la Salle St
Amarillo, TX 79106-5913
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2067687 | Other | TX | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2067687 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311206400000",
"number": "1558659789",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1716 S LA SALLE ST",
"city": "AMARILLO",
"state": "TX",
"postal_code": "791065913"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1250 WALLACE BLVD",
"city": "AMARILLO",
"state": "TX",
"postal_code": "791061741",
"telephone_number": "806-353-3596"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "HAILEY",
"middle_name": "RENE",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-07-21",
"last_updated": "2011-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2067687",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "2067687",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Amarillo, TX
- Full Smile Dental, PLLC (Full Smile Dental)
- Full Smile Endodontics, PLLC
- Full Smile Periodontics, PLLC
- Full Smile Prosthodontics PLLC
- Heather Dawn Fuller-Jones, M.S. CFY-SLP
- Stephen Fuller, DOCTOR OF CHIROPRACT
- Alton Wayne Funderburk Jr., CRNA
- Terry Lee Furgiuele, MD
- G&S Home Care LLC
- Mackenzie Gabel, PHARM.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.