Healthcare Provider Details

I. General information

NPI: 1578673984
Provider Name (Legal Business Name): ANGELIQUE HULL MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 HURFFVILLE CROSSKEYS RD SUITE 110
SEWELL NJ
08080-4002
US

IV. Provider business mailing address

84 GOLFVIEW DR
SEWELL NJ
08080-1816
US

V. Phone/Fax

Practice location:
  • Phone: 856-341-8500
  • Fax:
Mailing address:
  • Phone: 856-495-7666
  • 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: