Healthcare Provider Details

I. General information

NPI: 1356349385
Provider Name (Legal Business Name): GREG A HULSEY DPT, PT, ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2544 MANGUM ST
COMMERCE TX
75428-3515
US

IV. Provider business mailing address

2544 MANGUM ST
COMMERCE TX
75428-3515
US

V. Phone/Fax

Practice location:
  • Phone: 903-886-7669
  • Fax: 903-886-7679
Mailing address:
  • Phone: 903-886-7669
  • Fax: 903-886-7679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1061034
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: