Healthcare Provider Details

I. General information

NPI: 1275090235
Provider Name (Legal Business Name): ALBERT P HULLEY PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 SUMMER ST
REHOBOTH MA
02769-2221
US

IV. Provider business mailing address

1000 EDDY ST
PROVIDENCE RI
02905-4739
US

V. Phone/Fax

Practice location:
  • Phone: 508-252-5814
  • Fax:
Mailing address:
  • Phone: 401-533-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8548
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: