Provider Demographics
NPI:1902150972
Name:FULLER, RONALD ARTHUR (PTA)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:ARTHUR
Last Name:FULLER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-2814
Mailing Address - Country:US
Mailing Address - Phone:603-527-8106
Mailing Address - Fax:603-527-8142
Practice Address - Street 1:435 UNION AVE
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-2918
Practice Address - Country:US
Practice Address - Phone:603-527-8106
Practice Address - Fax:603-527-8142
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH202225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant