Healthcare Provider Details

I. General information

NPI: 1841729613
Provider Name (Legal Business Name): DAVID M HURLEY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 06/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 MERCHANDISE MART PLZ STE 951
CHICAGO IL
60654-1133
US

IV. Provider business mailing address

625 ENTERPRISE DR
OAK BROOK IL
60523-8813
US

V. Phone/Fax

Practice location:
  • Phone: 312-802-4642
  • Fax:
Mailing address:
  • Phone: 630-575-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070022962
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: