Healthcare Provider Details

I. General information

NPI: 1518680974
Provider Name (Legal Business Name): MOLLY SUZANNE HURT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY SUZANNE FLEMING

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S MAIN ST
FRANKLIN KY
42134-2370
US

IV. Provider business mailing address

PO BOX 2697
BOWLING GREEN KY
42102-7697
US

V. Phone/Fax

Practice location:
  • Phone: 270-586-8947
  • Fax: 270-813-1173
Mailing address:
  • Phone: 270-745-1100
  • Fax: 270-745-1156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2022075
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: