Healthcare Provider Details

I. General information

NPI: 1881884070
Provider Name (Legal Business Name): ELLEN HURTADO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6849 PEACHTREE DUNWOODY RD NE BLDG B1, SUITE 102
ATLANTA GA
30328-1610
US

IV. Provider business mailing address

1417 HIGHLAND LAKE CIR
DECATUR GA
30033-3452
US

V. Phone/Fax

Practice location:
  • Phone: 866-587-9922
  • Fax:
Mailing address:
  • Phone: 404-963-7172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007687
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: