Provider Demographics
NPI:1275206047
Name:HULSE, TANNER (PT)
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:HULSE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 CHRISTIE WAY APT 63H
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-4766
Mailing Address - Country:US
Mailing Address - Phone:949-939-0791
Mailing Address - Fax:
Practice Address - Street 1:730 MAIN ST STE 2D
Practice Address - Street 2:
Practice Address - City:MILLIS
Practice Address - State:MA
Practice Address - Zip Code:02054-1612
Practice Address - Country:US
Practice Address - Phone:508-376-0881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25558225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist