Provider Demographics
NPI:1245682525
Name:HULLMAN, CODY (PT)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:HULLMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 W 94TH TER STE 112
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207-2534
Mailing Address - Country:US
Mailing Address - Phone:913-224-2990
Mailing Address - Fax:913-224-2992
Practice Address - Street 1:5200 W 94TH TER STE 112
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207-2534
Practice Address - Country:US
Practice Address - Phone:913-224-2990
Practice Address - Fax:913-224-2992
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017021992225100000X
KS11-05324225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist