Healthcare Provider Details

I. General information

NPI: 1639562382
Provider Name (Legal Business Name): CYNTHIA HURLBERT PT, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4754 MARTIN RD STE 200
FLOWERY BRANCH GA
30542
US

IV. Provider business mailing address

4127 ASHFORD WAY
GAINESVILLE GA
30507
US

V. Phone/Fax

Practice location:
  • Phone: 770-967-4377
  • Fax: 770-967-8077
Mailing address:
  • Phone: 770-534-6543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT001312
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: