Healthcare Provider Details

I. General information

NPI: 1538309505
Provider Name (Legal Business Name): LAURA HURLEY MSPT, CSCS, CEAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 1ST AVE
NEEDHAM MA
02494-2824
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 781-449-2280
  • Fax: 781-449-2290
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15091
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: