Healthcare Provider Details

I. General information

NPI: 1558443697
Provider Name (Legal Business Name): LYNNRAE - HULBERT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N MAIN ST
WARSAW NY
14569-1025
US

IV. Provider business mailing address

PO BOX 18
GAINESVILLE NY
14066-0018
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-2233
  • Fax:
Mailing address:
  • Phone: 585-493-3427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number005613-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: