Healthcare Provider Details

I. General information

NPI: 1033410782
Provider Name (Legal Business Name): KARL TRUE HURST PT2020
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 W MAIN ST
GREEN FOREST AR
72638-2316
US

IV. Provider business mailing address

10914 CRICKET CUTOFF
OMAHA AR
72662-9375
US

V. Phone/Fax

Practice location:
  • Phone: 870-391-6313
  • Fax:
Mailing address:
  • Phone: 870-391-6313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT2020
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2020
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: