Healthcare Provider Details

I. General information

NPI: 1164678553
Provider Name (Legal Business Name): RYAN C HURLEY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 WILLIMANSETT ST 4135338502
SOUTH HADLEY MA
01075-3062
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 413-533-8501
  • Fax: 413-533-8502
Mailing address:
  • Phone: 630-296-2223
  • Fax: 630-759-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18391
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: