Healthcare Provider Details

I. General information

NPI: 1700658002
Provider Name (Legal Business Name): AUDREY LOREN HULETTE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 TATES CREEK CENTRE DR STE 144
LEXINGTON KY
40517-3068
US

IV. Provider business mailing address

4101 TATES CREEK CENTRE DR STE 144
LEXINGTON KY
40517-3068
US

V. Phone/Fax

Practice location:
  • Phone: 859-271-2887
  • Fax:
Mailing address:
  • Phone: 859-271-2887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number008951
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: