Provider Demographics
NPI:1851418800
Name:HULTINE, DEBRA KAY (PT)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:KAY
Last Name:HULTINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 DOVER DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61362-1004
Mailing Address - Country:US
Mailing Address - Phone:815-664-2674
Mailing Address - Fax:815-224-4512
Practice Address - Street 1:941 6TH ST
Practice Address - Street 2:
Practice Address - City:LA SALLE
Practice Address - State:IL
Practice Address - Zip Code:61301-2205
Practice Address - Country:US
Practice Address - Phone:815-224-3261
Practice Address - Fax:815-224-4512
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist