Healthcare Provider Details

I. General information

NPI: 1326713009
Provider Name (Legal Business Name): TROY EUGENE HURTT LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 W CLEVELAND RD STE B
GRANGER IN
46530-5638
US

IV. Provider business mailing address

418 W CLEVELAND RD STE B
GRANGER IN
46530-5638
US

V. Phone/Fax

Practice location:
  • Phone: 574-271-8424
  • Fax: 574-271-8425
Mailing address:
  • Phone: 574-271-8424
  • Fax: 574-271-8425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT21906772
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: