Healthcare Provider Details

I. General information

NPI: 1962590638
Provider Name (Legal Business Name): VALERIE JANE HULLETT PTA, CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 2ND AVE NW
FARIBAULT MN
55021-3035
US

IV. Provider business mailing address

1381 JEFFERSON RD
NORTHFIELD MN
55057-3080
US

V. Phone/Fax

Practice location:
  • Phone: 507-334-9400
  • Fax: 507-331-2210
Mailing address:
  • Phone: 507-646-8800
  • Fax: 507-646-8801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: