Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Timothy Michael Fullmer, MSPT

Individual provider Physical Therapist · NPI 1104989268

Mr. Timothy Michael Fullmer, MSPT is a Physical Therapist in Waverly, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2006
Specialties on file
2

Practice location Address checks out

150 Broad St
Waverly, NY 14892-1361
Phone: (607) 687-2495
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 022693-1 (NY)
Physical Therapist Taxonomy 225100000X · Licence 022693 (NY)

Record details

NPI number1104989268
Entity typeIndividual (Type 1)
GenderMale
Credentials MSPT
Sole proprietorYes
NPI enumeratedDecember 19, 2006
Last updated in NPPESMarch 26, 2021
Certification dateMarch 25, 2021
Mailing address150 Broad St, Waverly, NY 14892-1361

Other providers in Waverly