Provider Demographics
NPI:1881917946
Name:POLZIN, ANNA FULLER (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:FULLER
Last Name:POLZIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:ELIZABETH
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:PO BOX 306393
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6393
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:
Practice Address - Street 1:5541 GROVE BLVD STE C2
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-4600
Practice Address - Country:US
Practice Address - Phone:205-277-6870
Practice Address - Fax:205-277-6871
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH5778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I653551Medicare Oscar/Certification