Healthcare Provider Details

I. General information

NPI: 1174501167
Provider Name (Legal Business Name): SHERI ANN KULLING PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 OGDEN AVENUE
HINSDALE IL
60521
US

IV. Provider business mailing address

6730 CLARENDON HILLS RD
DARIEN IL
60561-3841
US

V. Phone/Fax

Practice location:
  • Phone: 630-655-8785
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: