Provider Demographics
NPI:1891533535
Name:NULSEN, HAILEY
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:NULSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W BABCOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4446
Mailing Address - Country:US
Mailing Address - Phone:301-922-2289
Mailing Address - Fax:
Practice Address - Street 1:630 BOARDWALK AVE STE 1
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4118
Practice Address - Country:US
Practice Address - Phone:406-548-6266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist