Jeffrey C Fultz, DC PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2639 Issued in AK

Practice address

3245 Hospital Dr
Juneau, AK 99801-7809

Phone

(907) 463-6682

Fax

(907) 463-6648

NPI assigned

Dec 8, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

Practice roles

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

• DHHS, PHS, Naihs, Shiprock Hospital

  • General Acute Care Hospital
  • Teec Nos Pos, AZ
  • NPI 1477615789
  NPD (past)

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

{
    "created_epoch": "1134000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376438400000",
    "number": "1366427676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 HOSPITAL DR",
            "city": "JUNEAU",
            "state": "AK",
            "postal_code": "998017809",
            "telephone_number": "907-463-6682",
            "fax_number": "907-463-6648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3245 HOSPITAL DR",
            "city": "JUNEAU",
            "state": "AK",
            "postal_code": "998017809",
            "telephone_number": "907-463-6682",
            "fax_number": "907-463-6648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULTZ",
        "first_name": "JEFFREY",
        "middle_name": "C",
        "credential": "DC PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-08",
        "last_updated": "2013-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "857",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "1694",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AK",
            "license": "2639",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "446551",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "93438061",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "29783739",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Juneau, AK
• Providers in Juneau, AK by specialty
• Physical Therapist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.