Healthcare Provider Details

I. General information

NPI: 1043607021
Provider Name (Legal Business Name): ELLEN DAVIS HULSE PT, DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11930 BOYETTE RD
RIVERVIEW FL
33569-5601
US

IV. Provider business mailing address

916 S ROME AVE APT 3
TAMPA FL
33606-3049
US

V. Phone/Fax

Practice location:
  • Phone: 813-671-1022
  • Fax:
Mailing address:
  • Phone: 301-873-0914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT37121
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number37121
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: