Provider Demographics
NPI:1235321811
Name:THE DR. DALE B. HULL FOUNDATION FOR NEUROLOGICAL REHABILITATION, INC.
Entity type:Organization
Organization Name:THE DR. DALE B. HULL FOUNDATION FOR NEUROLOGICAL REHABILITATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:801-619-3670
Mailing Address - Street 1:90 W ALBION VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-4013
Mailing Address - Country:US
Mailing Address - Phone:801-619-3670
Mailing Address - Fax:801-619-3679
Practice Address - Street 1:90 W ALBION VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-4013
Practice Address - Country:US
Practice Address - Phone:801-619-3670
Practice Address - Fax:801-619-3679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT120890-24012251N0400X
UT352686-24012251N0400X
UT801-479-0601225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057766Medicare PIN