Provider Demographics
NPI:1578025334
Name:TULLEY, ZACHARY (DPT)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:TULLEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8059 STAGE HILLS BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4071
Mailing Address - Country:US
Mailing Address - Phone:901-383-4515
Mailing Address - Fax:901-373-4515
Practice Address - Street 1:7501 GOODMAN RD STE I
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-1952
Practice Address - Country:US
Practice Address - Phone:901-383-4515
Practice Address - Fax:901-373-4515
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT12188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSPT6865OtherSTATE LICENSE NUMBER
TNPT12188OtherSTATE LICENSE NUMBER