Healthcare Provider Details

I. General information

NPI: 1467113407
Provider Name (Legal Business Name): MARY ELIZABETH HULS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 01/03/2022
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2253 VIRGINIA PLACE NE
ATLANTA GA
30305
US

IV. Provider business mailing address

2253 VIRGINIA PLACE NE
ATLANTA GA
30305
US

V. Phone/Fax

Practice location:
  • Phone: 404-467-4900
  • Fax:
Mailing address:
  • Phone: 614-557-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT012186
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: