Healthcare Provider Details

I. General information

NPI: 1851729396
Provider Name (Legal Business Name): AMBER ELENA HURLEY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER ELENA PINNOW

II. Dates (important events)

Enumeration Date: 10/18/2013
Last Update Date: 10/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S 4TH ST W
BAKER MT
59313-9156
US

IV. Provider business mailing address

PO BOX 820
BAKER MT
59313-0820
US

V. Phone/Fax

Practice location:
  • Phone: 406-778-3331
  • Fax: 406-778-5163
Mailing address:
  • Phone: 406-778-3331
  • Fax: 406-778-5163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2126
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1517
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: