Provider Demographics
NPI:1932412913
Name:ULLRICH, GENIE SIEBER (PT)
Entity type:Individual
Prefix:MRS
First Name:GENIE
Middle Name:SIEBER
Last Name:ULLRICH
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 1:1034 REELFOOT ST
Mailing Address - Street 2:
Mailing Address - City:TIPTONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38079-1607
Mailing Address - Country:US
Mailing Address - Phone:731-253-7266
Mailing Address - Fax:731-253-7267
Practice Address - Street 1:1034 REELFOOT ST
Practice Address - Street 2:
Practice Address - City:TIPTONVILLE
Practice Address - State:TN
Practice Address - Zip Code:38079-1607
Practice Address - Country:US
Practice Address - Phone:731-253-6681
Practice Address - Fax:731-253-8014
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2791225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist