Healthcare Provider Details

I. General information

NPI: 1518566926
Provider Name (Legal Business Name): VIRGINIA HURLEY DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 S MOUNTAIN RD
JOPPA MD
21085-3202
US

IV. Provider business mailing address

PO BOX 179
FOREST HILL MD
21050-0179
US

V. Phone/Fax

Practice location:
  • Phone: 410-676-6767
  • Fax: 410-676-6770
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01958500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28119
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: