Provider Demographics
NPI:1346056595
Name:FULLER, HAYDEN REESE
Entity type:Individual
Prefix:
First Name:HAYDEN
Middle Name:REESE
Last Name:FULLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 W UNION HILLS DR STE 320
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8181
Mailing Address - Country:US
Mailing Address - Phone:623-248-8830
Mailing Address - Fax:623-248-8772
Practice Address - Street 1:8110 W UNION HILLS DR STE 320
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8181
Practice Address - Country:US
Practice Address - Phone:623-248-8830
Practice Address - Fax:623-248-8772
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist