Healthcare Provider Details

I. General information

NPI: 1679284061
Provider Name (Legal Business Name): CHRISTI HURD L, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 VAUGHN RD
MONTGOMERY AL
36116-1153
US

IV. Provider business mailing address

510 KIMRICK DR
DEATSVILLE AL
36022-2675
US

V. Phone/Fax

Practice location:
  • Phone: 334-272-7220
  • Fax:
Mailing address:
  • Phone: 334-669-2673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number647
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: