Healthcare Provider Details

I. General information

NPI: 1194964197
Provider Name (Legal Business Name): MAXINE PATORA HURLEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 02/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 S FEDERAL HWY
BOYNTON BEACH FL
33435-6967
US

IV. Provider business mailing address

2222 SULLIVAN TRL
EASTON PA
18040-7958
US

V. Phone/Fax

Practice location:
  • Phone: 561-736-2424
  • Fax: 561-736-2424
Mailing address:
  • Phone: 800-944-9782
  • Fax: 610-438-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT21823
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: