Healthcare Provider Details

I. General information

NPI: 1588231740
Provider Name (Legal Business Name): SEAN HURLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 E OVERLAND RD
MERIDIAN ID
83642-6751
US

IV. Provider business mailing address

16083 SW UPPER BOONES FERRY RD STE 300
PORTLAND OR
97224-7736
US

V. Phone/Fax

Practice location:
  • Phone: 208-888-7765
  • Fax: 208-888-7955
Mailing address:
  • Phone: 503-443-6156
  • 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: