Provider Demographics
NPI:1295701142
Name:FULTZ, SARA LYNN (MPT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LYNN
Last Name:FULTZ
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:LYNN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:800 CRESCENT CENTRE DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7269
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:7796 WOLF TRAIL CV
Practice Address - Street 2:SUITE 102
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1782
Practice Address - Country:US
Practice Address - Phone:901-624-5020
Practice Address - Fax:901-624-5021
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6730225100000X
TN6462225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ015354Medicaid