Provider Demographics
NPI:1467414870
Name:STULL, IRIS R (MS PT)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:R
Last Name:STULL
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:IRIS
Other - Middle Name:R
Other - Last Name:ADKISSION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS PT
Mailing Address - Street 1:3985 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-9631
Mailing Address - Country:US
Mailing Address - Phone:270-422-8176
Mailing Address - Fax:
Practice Address - Street 1:815 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-1415
Practice Address - Country:US
Practice Address - Phone:270-422-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT 004100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5029402Medicare ID - Type Unspecified