Provider Demographics
NPI:1447816442
Name:HULSEY, BROCK EDWARD (PT)
Entity type:Individual
Prefix:DR
First Name:BROCK
Middle Name:EDWARD
Last Name:HULSEY
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 1:920 DEON DR
Mailing Address - Street 2:STE D
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201
Mailing Address - Country:US
Mailing Address - Phone:208-425-1470
Mailing Address - Fax:208-425-1471
Practice Address - Street 1:920 DEON DR
Practice Address - Street 2:STE D
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:208-425-1470
Practice Address - Fax:208-425-1471
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist