Healthcare Provider Details

I. General information

NPI: 1033327986
Provider Name (Legal Business Name): TUTTLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 W TWO MILE HOUSE RD SUITE C
COLUMBUS IN
47201-9242
US

IV. Provider business mailing address

PO BOX 1289
COLUMBUS IN
47202-1289
US

V. Phone/Fax

Practice location:
  • Phone: 812-342-3859
  • Fax: 812-342-4760
Mailing address:
  • Phone: 812-342-3859
  • Fax: 812-342-4760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number01057718A
License Number StateIN

VIII. Authorized Official

Name: DR. JULIE LYNN TUTTLE
Title or Position: OWNER
Credential: M.D.
Phone: 812-824-8787