Provider Demographics
NPI:1619730397
Name:HULL, BROOKLYN (DPT)
Entity Type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:
Last Name:HULL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MADRID
Mailing Address - State:IA
Mailing Address - Zip Code:50156-1607
Mailing Address - Country:US
Mailing Address - Phone:515-795-5058
Mailing Address - Fax:
Practice Address - Street 1:411 E 6TH ST
Practice Address - Street 2:
Practice Address - City:MADRID
Practice Address - State:IA
Practice Address - Zip Code:50156-1607
Practice Address - Country:US
Practice Address - Phone:515-795-5058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA123442208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation