Healthcare Provider Details

I. General information

NPI: 1538597307
Provider Name (Legal Business Name): DANA KURTY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2013
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 DUNN AVE
DAYTONA BEACH FL
32114-2405
US

IV. Provider business mailing address

1710 N PENINSULA AVE
NEW SMYRNA BEACH FL
32169-2132
US

V. Phone/Fax

Practice location:
  • Phone: 386-255-4568
  • Fax:
Mailing address:
  • Phone: 386-299-3849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT6304
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: