Individual
ZACHARY TULLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
7501 GOODMAN RD STE I, OLIVE BRANCH, MS 38654-1952
(901) 383-4515
(901) 373-4515
Mailing address
8059 STAGE HILLS BLVD STE 104, BARTLETT, TN 38133-4071
(901) 383-4515
(901) 373-4515
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT12188
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT12188
STATE LICENSE NUMBER
TN
01
—
PT6865
STATE LICENSE NUMBER
MS
Enumeration date
04/02/2019
Last updated
02/26/2020
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