Healthcare Provider Details

I. General information

NPI: 1497337521
Provider Name (Legal Business Name): JACOB HURLEY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 35TH LN
VERO BEACH FL
32960-6521
US

IV. Provider business mailing address

5440 CLAIRMONT LN
NORTH CHARLESTON SC
29420-7803
US

V. Phone/Fax

Practice location:
  • Phone: 772-569-2330
  • Fax:
Mailing address:
  • Phone: 239-233-3049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number36896
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: