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General NPI Number Information
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NPI Number | 1912473034
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Entity Type | Organization
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Legal Business Name | FULTZ PHYSICAL THERAPY AND JOINT REHAB, LLC
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Dates
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Enumeration Date | 10/16/2018
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 9462 ELLERBE RD STE 200
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City | SHREVEPORT
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State | LA
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Zip | 71106-7466
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Country | US
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Telephone | 318-606-5262
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Fax | 318-402-0802
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Provider Business Mailing Address
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Address Line | 9462 ELLERBE RD STE 200
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City | SHREVEPORT
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State | LA
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Zip | 71106-7466
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Country | US
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Telephone | 318-606-5262
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Fax | 318-402-0802
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Authorized Official
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Title or Position | P.T./OWNER
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Name | CHRISTOPHER FULTZ
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Credential | P.T.
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Telephone | 318-606-5262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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