Provider Demographics
NPI:1629221155
Name:GULLE, DENNIS
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:
Last Name:GULLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N WASHINGTON AVE
Mailing Address - Street 2:APT. 18
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1752
Mailing Address - Country:US
Mailing Address - Phone:914-831-7736
Mailing Address - Fax:914-682-7045
Practice Address - Street 1:125 N WASHINGTON AVE
Practice Address - Street 2:APT. 18
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1752
Practice Address - Country:US
Practice Address - Phone:914-831-7736
Practice Address - Fax:914-682-7045
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013157-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist