Provider Demographics
NPI:1912473034
Name:FULTZ PHYSICAL THERAPY AND JOINT REHAB, LLC
Entity Type:Organization
Organization Name:FULTZ PHYSICAL THERAPY AND JOINT REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P.T./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:FULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:318-606-5262
Mailing Address - Street 1:9462 ELLERBE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7466
Mailing Address - Country:US
Mailing Address - Phone:318-606-5262
Mailing Address - Fax:318-402-0802
Practice Address - Street 1:9462 ELLERBE RD STE 200
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7466
Practice Address - Country:US
Practice Address - Phone:318-606-5262
Practice Address - Fax:318-402-0802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-16
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1952790917OtherNPI