Provider Demographics
NPI:1932161940
Name:ULRICH, AUTUMN RACHEL (PT)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:RACHEL
Last Name:ULRICH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:RACHEL
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:270 CHASTAIN RD NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-3012
Mailing Address - Country:US
Mailing Address - Phone:678-594-6080
Mailing Address - Fax:678-594-6081
Practice Address - Street 1:270 CHASTAIN RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-3012
Practice Address - Country:US
Practice Address - Phone:678-594-6080
Practice Address - Fax:678-594-6081
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0073782251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic