Healthcare Provider Details

I. General information

NPI: 1750864666
Provider Name (Legal Business Name): PHILLIP HURLIMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 31ST ST S
ST PETERSBURG FL
33712-4051
US

IV. Provider business mailing address

4201 31ST ST S
SAINT PETERSBURG FL
33712-4051
US

V. Phone/Fax

Practice location:
  • Phone: 727-867-1104
  • Fax:
Mailing address:
  • Phone: 727-867-1104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: