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NPI Code Detail

MEDICARE: MS. TRACY E HULLEMAN PT

MEDICARE: MS. TRACY E HULLEMAN PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist4835OR

General Provider Information

NPI Number : 1356555429
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TRACY E HULLEMAN PT
Provider Business Mailing Address
First Line : PO BOX 3158
Second Line :
City : PORTLAND
State : OR
Zip : 97208-3158
Country : US
Telephone Number : 503-215-6494
Fax Number :
Provider Business Practice Location Address
First Line : 12345 SW HORIZON BLVD STE 57
Second Line :
City : BEAVERTON
State : OR
Zip : 97007-9475
Country : US
Telephone Number : 503-216-8825
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2007
Last Update Date : 11/18/2020

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Directions to “ MS. TRACY E HULLEMAN PT” Practice Location

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