Individual provider · Type 1 NPI
Koren Fuller
Massage Therapist · Coal Valley, IL
NPI number
1639019003
Active
Practice location
102 W 1st Ave
Coal Valley, IL 61240-9308
Mailing address
401 Walnut St
Port Byron, IL 61275-9559
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Massage Therapist Primary | 225700000X | 227023901 (IL) |
Massage Therapist: An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes.
2 other providers at this address
About NPI 1639019003
Koren Fuller's National Provider Identifier is 1639019003, issued on Mar 28, 2026. The primary taxonomy on file is Massage Therapist (225700000X), and the practice location is in Coal Valley, IL. The record was last updated on Mar 28, 2026.