Healthcare Provider Details

I. General information

NPI: 1336810266
Provider Name (Legal Business Name): GEOFFREY HULSE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 01/28/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MOUNTAIN ROAD FL 2
SUFFIELD CT
06078
US

IV. Provider business mailing address

435 HARTFORD TPKE STE U
VERNON CT
06066-4834
US

V. Phone/Fax

Practice location:
  • Phone: 860-668-9589
  • Fax:
Mailing address:
  • Phone: 860-979-1611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: