Healthcare Provider Details

I. General information

NPI: 1508428566
Provider Name (Legal Business Name): REX HURLBUT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2019
Last Update Date: 06/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 HAWTHORNE LN
GREENWOOD IN
46142-9430
US

IV. Provider business mailing address

124 HAWTHORNE LN
GREENWOOD IN
46142-9430
US

V. Phone/Fax

Practice location:
  • Phone: 317-452-2342
  • Fax: 317-332-9861
Mailing address:
  • Phone: 317-452-2342
  • Fax: 317-332-9861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05011675A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: