Healthcare Provider Details

I. General information

NPI: 1316227515
Provider Name (Legal Business Name): RYAN HULING DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6542 GOODMAN RD STE 101
OLIVE BRANCH MS
38654-5559
US

IV. Provider business mailing address

6542 GOODMAN RD STE 101
OLIVE BRANCH MS
38654-5559
US

V. Phone/Fax

Practice location:
  • Phone: 662-874-5964
  • Fax: 662-874-5176
Mailing address:
  • Phone: 662-874-5964
  • Fax: 662-874-5176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10294
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT4918
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT4918
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: