Provider Demographics
NPI:1659858363
Name:INHULSEN, ADRIAN (PTA)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:INHULSEN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 AVE AT PORT IMPERIAL BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-6960
Mailing Address - Country:US
Mailing Address - Phone:201-272-9400
Mailing Address - Fax:201-272-9402
Practice Address - Street 1:500 AVE AT PORT IMPERIAL BLVD STE 110
Practice Address - Street 2:
Practice Address - City:WEEHAWKEN
Practice Address - State:NJ
Practice Address - Zip Code:07086-6960
Practice Address - Country:US
Practice Address - Phone:201-272-9400
Practice Address - Fax:201-272-9402
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00349500225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant