Provider Demographics
NPI:1245516483
Name:HULTS, DALE EVON (PT)
Entity type:Individual
Prefix:MRS
First Name:DALE
Middle Name:EVON
Last Name:HULTS
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 1:167 NORTHWOODS CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MINERVA
Mailing Address - State:NY
Mailing Address - Zip Code:12851-2046
Mailing Address - Country:US
Mailing Address - Phone:518-251-4324
Mailing Address - Fax:
Practice Address - Street 1:81 NORTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:NY
Practice Address - Zip Code:12117
Practice Address - Country:US
Practice Address - Phone:518-661-5352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004887-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist