Provider Demographics
NPI:1013069590
Name:TULLIS, AMY KATHRYN (PT, MPT)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:KATHRYN
Last Name:TULLIS
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MEADOW LARK DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-3905
Mailing Address - Country:US
Mailing Address - Phone:302-222-0337
Mailing Address - Fax:
Practice Address - Street 1:97 COMMERCE WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-8228
Practice Address - Country:US
Practice Address - Phone:302-734-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0001516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist