Diana Fuller

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2177085 Issued in TX

Practice address

2545 Perryton Pkwy Ste 35
Pampa, TX 79065-2820

Phone

(806) 486-1697

NPI assigned

Jul 9, 2024

Last updated

Jul 9, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Diana Salazar Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1720483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720483200000",
    "number": "1811734767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2545 PERRYTON PKWY STE 35",
            "city": "PAMPA",
            "state": "TX",
            "postal_code": "790652820",
            "telephone_number": "806-486-1697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2545 PERRYTON PKWY STE 35",
            "city": "PAMPA",
            "state": "TX",
            "postal_code": "790652820",
            "telephone_number": "806-486-1697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "DIANA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-09",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2177085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANA",
            "last_name": "SALAZAR",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mark Wayne Ford Jr., D.C.
• Samantha Ashley Ford, D.C.
• Serenity Ford, CNC, CPT
• Mayra Louise Freeman-Ladd, MD
• Frogge Enterprises Inc (Family Pharmacy of Pampa)
• Joanne R Genn, FNP-C
• Giang T. Nguyen, MD, PA
• Lisa Gibson, LPC
• Gloria M Trirogoff MD PA
• Brooke Nichole Godino, P.T.

• Physical Therapy Assistant in Pampa, TX
• Providers in Pampa, TX by specialty
• Physical Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.