Healthcare Provider Details

I. General information

NPI: 1710524343
Provider Name (Legal Business Name): CASEY ANNE HURLEY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7315 E FRONTAGE RD STE 120
MERRIAM KS
66204-1658
US

IV. Provider business mailing address

1670 HEDGE APPLE DR
SEDALIA MO
65301-8960
US

V. Phone/Fax

Practice location:
  • Phone: 913-676-2444
  • Fax:
Mailing address:
  • Phone: 660-473-1732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-06249
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: