Provider Demographics
NPI:1659736882
Name:HULSE, COREY BENJAMIN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:BENJAMIN
Last Name:HULSE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2578 CENTERGATE DR
Mailing Address - Street 2:APT. 101
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7258
Mailing Address - Country:US
Mailing Address - Phone:239-980-3807
Mailing Address - Fax:
Practice Address - Street 1:3325 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6999
Practice Address - Country:US
Practice Address - Phone:954-986-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT30942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist