MEDICARE: CASEY E HURLBURT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA71994	FL

General Provider Information

NPI Number	:	1669086815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY E HURLBURT

Provider Business Mailing Address
First Line	:	736 NIGHTHAWK WAY
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-4226
Country	:	US
Telephone Number	:	561-676-3693
Fax Number	:

Provider Business Practice Location Address
First Line	:	736 NIGHTHAWK WAY
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-4226
Country	:	US
Telephone Number	:	561-676-3693
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2020
Last Update Date	:	09/04/2020

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