MR. BRYAN CARROLL FULLER (NPI# 1487089124) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487089124 |
| Entity Type | Individual |
| Full Name | MR. BRYAN CARROLL FULLER |
| Credential | CPO |
| Practice Address |
612 Rio Rd W Ste 5 Charlottesville VA 22901-1412 |
| Practice Telephone | 4345298882 |
| Practice Fax Number | 4345298882 |
| Mailing Telephone | (434) 529-8882 |
| Mailing Fax Number | 4345298942 |
| Enumeration Date | 2013-09-12 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 222Z00000X | Orthotist | 1298 | DE | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| N | 224P00000X | Prosthetist | 1298 | DE | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 1215362850 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 200 W 12th St, Waynesboro, VA 229804771 | 5409499089 | 5409499089 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285682146 | Bryan L Fuller | Optometrist | 4665 E Cactus Rd, Phoenix, AZ 85032-7703 | 2006-05-04 |
| 1487694790 | Bryan Dale Fuller | Specialist | 625 United Dr Ste 220, Conway, AR 72032-7835 | 2006-06-07 |
| 1104898592 | Bryan Fuller | Internal Medicine | 1005 E Ring Rd, Ironton, OH 45638-9610 | 2006-02-02 |
| Street Address |
612 RIO RD W STE 5 |
| City | CHARLOTTESVILLE |
| State | VA |
| Zip Code | 22901-1412 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215362850 | Fuller's Orthopedic | Clinic/Center | 612 Rio Rd W Ste 5, Charlottesville, VA 22901-1412 | 2013-09-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124641501 | John Mccord | Speech-Language Pathologist | English Meadows, 1220 Crozet Ave, Crozet, VA 22901 | 2020-05-20 |
| 1922566017 | The Kroger Co | Durable Medical Equipment & Medical Supplies | 27 Discovery Dr, Bluffton, SC 22901 | 2019-03-07 |
| 1477011872 | Courtney Dyan Bonilla | Counselor | 633 Berkmar Circle, Charlottesville, VA 22901 | 2019-03-05 |
| 1558855346 | Dana Scott | Counselor | 696 Berkmar Cir Ste 3b, Charlottesville, VA 22901 | 2018-06-15 |
| 1043725336 | M Clinic, LLC | Internal Medicine | 406 Albemarle Square, Charlottesville, VA 22901 | 2017-12-08 |
| 1033620380 | Cheryl K Cottrell | Counselor | 875 East Rio Court, Charlottesville, VA 22901 | 2017-10-13 |
| 1114389640 | Heather Lorin Broach | Physical Therapist | 2331 Seminole Ln Ste 103, Charlottesville, VA 22901 | 2016-03-23 |
| 1649669904 | Costco Wholesale Corporation | Pharmacy | 3171 District Ave, Charlottesville, VA 22901 | 2015-01-09 |
| 1083988778 | Melissa Stanley | Nurse Practitioner | 1356 River Rd, Charlottesville, VA 22901 | 2012-02-28 |
| 1982977633 | Jea Catherine Brickwedde | Specialist | 716 Rio Rd W, Fa, Charlottesville, VA 22901 | 2012-02-10 |
| Find all providers in zip 22901 | ||||
| Taxonomy Code | 222Z00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Orthotist |
| A health care professional who is specifically educated and trained to manage comprehensive orthotic patient care, including musculoskeletal and neuromuscular anomalies resulting from injuries or disease processes involving the lower extremity, upper extremity or spinal segment/s and positional deformation of the cranium. Orthotists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639647993 | Madison Vansavage Maben | Orthotist | 433 Network Sta, Chesapeake, VA 23320 | 2018-11-05 |
| 1851883318 | Specialized Orthopaedic Services,inc. | Orthotist | 1951 Evelyn Byrd Ave Ste E, Harrisonburg, VA 22801-3483 | 2018-05-31 |
| 1366988578 | Emily Kane | Orthotist | 6320 N Center Dr Ste 201, Norfolk, VA 23502-4009 | 2017-01-11 |
| 1164887931 | Beth Martin | Orthotist | 2034 Dabney Rd Ste C, Richmond, VA 23230-3361 | 2015-12-22 |
| 1215361886 | Michael L. Butts | Orthotist | Dept of Veterans Affairs Hunter Holmes Ctr, 1201 Broad Rock Blvd, Richmond, VA 23249-0001 | 2013-08-30 |
| 1447592936 | Joseph L. Lawson | Orthotist | 1135 First Colonial Rd, Virginia Beach, VA 23454-2402 | 2013-03-22 |
| 1851631105 | Booden Orthopedic & Prosthetic Center Inc | Orthotist | 5511 Princess Anne Rd, Suite 101, Virginia Beach, VA 23462-3321 | 2013-02-25 |
| 1487905378 | Ksenia Noelle Major | Orthotist | 2139 Staples Mill Rd, Richmond, VA 23230-2905 | 2012-10-02 |
| 1780982660 | Carter P Williams | Orthotist | 1500 Huguenot Rd, Suite 106, Midlothian, VA 23113-2478 | 2011-03-02 |
| 1427284538 | Sarah A Lane | Orthotist | 1726 Amherst St Ste 600, Winchester, VA 22601-2807 | 2009-06-03 |
| Find all providers with the same taxonomy | ||||
| City | CHARLOTTESVILLE |
| Zip Code | 22901 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.