1174781629 NPI number — ROBIN LYNN HULBERT P.T.

Table of content: ROBIN LYNN HULBERT P.T. (NPI 1174781629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174781629 NPI number — ROBIN LYNN HULBERT P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HULBERT
Provider First Name:
ROBIN
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAYTON
Provider Other First Name:
ROBIN
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174781629
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
EATON CENTER 5TH FLOOR 26 CONKEY AVE, BOX 136
Provider Second Line Business Mailing Address:
SECO PT/OT PLLC
Provider Business Mailing Address City Name:
NORWICH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-334-5010
Provider Business Mailing Address Fax Number:
607-336-7326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 CARTWRIGHT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIDNEY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13838-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-563-2929
Provider Business Practice Location Address Fax Number:
607-563-2930
Provider Enumeration Date:
05/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  030290-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 030200000 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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