Healthcare Provider Details

I. General information

NPI: 1720242753
Provider Name (Legal Business Name): ANITA CHRISTINE HURLEY L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 SAWGRASS VILLAGE CIR SUITE #36
PONTE VEDRA FL
32082-5016
US

IV. Provider business mailing address

13000 SAWGRASS VILLAGE CIR SUITE #36
PONTE VEDRA FL
32082-5016
US

V. Phone/Fax

Practice location:
  • Phone: 904-273-9966
  • Fax:
Mailing address:
  • Phone: 904-273-9966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA30854
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: