Provider Demographics
NPI:1245376284
Name:HULL, SUSAN (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HULL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:ROYAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:11085 LITTLE PATUXENT PKWY STE 207
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2979
Mailing Address - Country:US
Mailing Address - Phone:410-884-4111
Mailing Address - Fax:410-884-4113
Practice Address - Street 1:11085 LITTLE PATUXENT PKWY STE 207
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2979
Practice Address - Country:US
Practice Address - Phone:410-884-4111
Practice Address - Fax:410-884-4113
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist