Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Nathan Thomas Fullam, DPT

Individual provider Physical Therapist · NPI 1265101935

Nathan Thomas Fullam, DPT is a Physical Therapist in Private Practice in West Berlin, New Jersey. Qualified in 2021, 5 years ago. Practices with Ipta Clinical, LLC, a 126-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in New Jersey.

Years since qualifying
5
Licensed in
NJ
In the registry since
2021
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

115 N Route 73 Unit 80
West Berlin, NJ 08091-9202
Phone: (856) 335-4938
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 413 W Crystal Lake Ave, Haddonfield, NJ 08033-2806 — (856) 240-7609

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 40QA02040500 (NJ)

Record details

NPI number1265101935
Entity typeIndividual (Type 1)
GenderMale
Credentials DPT
Sole proprietorNo
NPI enumeratedSeptember 7, 2021
Last updated in NPPESSeptember 7, 2021
Certification dateSeptember 1, 2021
Mailing address1225 Tristram Cir, Mantua, NJ 08051-2245

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Ipta Clinical, Llc — 126 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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