Healthcare Provider Details

I. General information

NPI: 1629018270
Provider Name (Legal Business Name): SOPHIA PETRELLA HURLEY MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5599 N DIXIE HWY
OAKLAND PARK FL
33334-3406
US

IV. Provider business mailing address

3767 SW 17TH ST
FORT LAUDERDALE FL
33312-3526
US

V. Phone/Fax

Practice location:
  • Phone: 954-229-7712
  • Fax:
Mailing address:
  • Phone: 954-625-2005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20921
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: