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NPI Code Detail

MEDICARE: GORDON C HURLBERT III ATC, CSCS

MEDICARE: GORDON C HURLBERT III ATC, CSCS
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
1174400000XSpecialist

General Provider Information

NPI Number : 1952389827
Entity Type Code : Individual
Provider Name (Legal Business Name) : GORDON C HURLBERT III ATC, CSCS
Provider Business Mailing Address
First Line : 275 MOUNT CARMEL AVE
Second Line : GM-ATH RM 135
City : HAMDEN
State : CT
Zip : 06518-1961
Country : US
Telephone Number : 203-582-8589
Fax Number : 203-582-3207
Provider Business Practice Location Address
First Line : 275 MOUNT CARMEL AVE
Second Line : GM-ATH RM 135
City : HAMDEN
State : CT
Zip : 06518-1961
Country : US
Telephone Number : 203-582-8589
Fax Number : 203-582-3207
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2006
Last Update Date : 07/08/2007

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