Basic Information
| Provider Information | |||||||||
| NPI: | 1750896791 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HULSEY | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 93 WALNUT DR | ||||||||
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| City: | CASEYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622322239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189774030 | ||||||||
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| Practice Location | |||||||||
| Address1: | 83 PROGRESS PKWY | ||||||||
| Address2: | |||||||||
| City: | MARYLAND HEIGHTS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630433701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144348174 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2017 | ||||||||
| LastUpdateDate: | 12/13/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2017039595 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.