Provider Demographics
NPI:1518130202
Name:HULL, STEPHANIE LEIGH (PTA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LEIGH
Last Name:HULL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 S CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:IL
Mailing Address - Zip Code:61254-1711
Mailing Address - Country:US
Mailing Address - Phone:309-944-9408
Mailing Address - Fax:
Practice Address - Street 1:613 S CHICAGO ST
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:IL
Practice Address - Zip Code:61254-1711
Practice Address - Country:US
Practice Address - Phone:309-944-9408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant