Andrew Fultz, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

15862 Issued in TN

Practice address

102 E Commerce CT
Jefferson City, TN 37760-3200

Phone

(865) 475-3101

Fax

(865) 475-9213

NPI assigned

Aug 13, 2024

Last updated

Aug 16, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Lincoln Memorial University Medical Department, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Optimus Health Center, Inc.Group PAC ID 9638173503, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Optimus Health Center, Inc.

  dba St. Luke's Therapy Services

  • Physical Therapist
  • Jefferson City, TN
  • NPI 1902822588
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1723507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1306677083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 E COMMERCE CT",
            "city": "JEFFERSON CITY",
            "state": "TN",
            "postal_code": "377603200",
            "telephone_number": "865-475-3101",
            "fax_number": "865-475-9213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 E COMMERCE CT",
            "city": "JEFFERSON CITY",
            "state": "TN",
            "postal_code": "377603200",
            "telephone_number": "865-475-3101",
            "fax_number": "865-475-9213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULTZ",
        "first_name": "ANDREW",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-13",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "15862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bonnie Forrester, LAC, DACM
• Evan Eugene Foulke, MD
• Kristopher William Fowler, PHARMD
• Margaret A Frazier, D.C.
• Jenna Marie Frost, PMHNP-BC
• Haley Fyffe
• Rachelle Gang, FNP
• Stephen C Gantte, M.D.
• Genesis Heart and Vascular Associates, PLLC
• Coree Georgenson, LAT, ATC

• Physical Therapist in Jefferson City, TN
• Providers in Jefferson City, TN by specialty
• Physical Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.