Healthcare Provider Details

I. General information

NPI: 1366603532
Provider Name (Legal Business Name): DUSTIN B HURD PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 07/18/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 SEWALL ST
PORTLAND ME
04102-2603
US

IV. Provider business mailing address

454 KIT CARSON
PRESIDIO OF MONTEREY CA
93940
US

V. Phone/Fax

Practice location:
  • Phone: 207-828-2100
  • Fax: 207-828-2190
Mailing address:
  • Phone: 831-242-6740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3426
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: