MEDICARE: ANGELIQUE HULL MSPT

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
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	40QA01159500	OTHER	NJ	LICENSE#

General Provider Information

NPI Number	:	1578673984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELIQUE HULL MSPT

Provider Business Mailing Address
First Line	:	84 GOLFVIEW DR
Second Line	:
City	:	SEWELL
State	:	NJ
Zip	:	08080-1816
Country	:	US
Telephone Number	:	856-495-7666
Fax Number	:

Provider Business Practice Location Address
First Line	:	239 HURFFVILLE CROSSKEYS RD
Second Line	:	SUITE 110
City	:	SEWELL
State	:	NJ
Zip	:	08080-4002
Country	:	US
Telephone Number	:	856-341-8500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	02/22/2010

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