Healthcare Provider Details

I. General information

NPI: 1497500516
Provider Name (Legal Business Name): MR. ANDREW LAWRENCE HURSH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N RITTER AVE
INDIANAPOLIS IN
46219-3027
US

IV. Provider business mailing address

612 ARDEN DR
INDIANAPOLIS IN
46220-1022
US

V. Phone/Fax

Practice location:
  • Phone: 800-777-7775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05011481A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: