Provider Demographics
NPI:1396876249
Name:HULL, AUTUMN DANIELLE (PT)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:DANIELLE
Last Name:HULL
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 1:5917 CHERRY BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-5058
Mailing Address - Country:US
Mailing Address - Phone:231-943-0398
Mailing Address - Fax:
Practice Address - Street 1:5222 N ROYAL DR STE D
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-6883
Practice Address - Country:US
Practice Address - Phone:231-929-5980
Practice Address - Fax:231-929-7252
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011735225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist