Healthcare Provider Details

I. General information

NPI: 1285260521
Provider Name (Legal Business Name): MIRISSA HURTIG PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85610 521ST AVE
CLEARWATER NE
68726-5230
US

IV. Provider business mailing address

85610 521ST AVE
CLEARWATER NE
68726-5230
US

V. Phone/Fax

Practice location:
  • Phone: 402-640-9737
  • Fax:
Mailing address:
  • Phone: 402-640-9737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1814
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: