Healthcare Provider Details

I. General information

NPI: 1558692913
Provider Name (Legal Business Name): KARL F. HURBAN L.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2417 LA VALLE AVE
VINELAND NJ
08360-6812
US

IV. Provider business mailing address

PO BOX 63
BRIDGETON NJ
08302-0048
US

V. Phone/Fax

Practice location:
  • Phone: 609-247-5483
  • Fax: 856-696-7861
Mailing address:
  • Phone: 856-451-9395
  • Fax: 856-451-8615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00374400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number40QA00374400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: