Provider Demographics
NPI:1558905125
Name:HULL, BRIANA RENAE (PTA)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:RENAE
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 1:545 N CARRIAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4506
Mailing Address - Country:US
Mailing Address - Phone:316-612-4900
Mailing Address - Fax:316-612-4999
Practice Address - Street 1:545 N CARRIAGE PKWY
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4506
Practice Address - Country:US
Practice Address - Phone:316-612-4900
Practice Address - Fax:316-612-4999
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03528225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant