Healthcare Provider Details

I. General information

NPI: 1457718728
Provider Name (Legal Business Name): CAROLYN HULL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2016
Last Update Date: 01/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3526 DUTCHMANS LN
LOUISVILLE KY
40205-3256
US

IV. Provider business mailing address

1844 FLEMING RD
LOUISVILLE KY
40205-2420
US

V. Phone/Fax

Practice location:
  • Phone: 502-452-0631
  • Fax:
Mailing address:
  • Phone:
  • 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: