Provider Demographics
NPI:1548335029
Name:TULLER, JENNI (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNI
Middle Name:
Last Name:TULLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 MATTHEW DR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-9337
Mailing Address - Country:US
Mailing Address - Phone:585-223-2257
Mailing Address - Fax:
Practice Address - Street 1:540 WHITE SPRUCE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1613
Practice Address - Country:US
Practice Address - Phone:585-427-7190
Practice Address - Fax:585-427-2287
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02221-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist