Provider Demographics
NPI:1215390729
Name:TULLI, AMBER (PTA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:TULLI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12700 BARTRAM PARK BLVD
Mailing Address - Street 2:120
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5406
Mailing Address - Country:US
Mailing Address - Phone:561-222-0323
Mailing Address - Fax:
Practice Address - Street 1:80 PINNACLES DR
Practice Address - Street 2:BLDG B, SUITE 800
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2323
Practice Address - Country:US
Practice Address - Phone:386-586-3887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA26039225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant