Healthcare Provider Details

I. General information

NPI: 1740618446
Provider Name (Legal Business Name): MARISA HURT P.T., D.P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7361 PRAIRIE FALCON RD STE 130
LAS VEGAS NV
89128-0824
US

IV. Provider business mailing address

7361 PRAIRIE FALCON RD STE 130
LAS VEGAS NV
89128-0824
US

V. Phone/Fax

Practice location:
  • Phone: 702-804-1511
  • Fax: 702-804-2551
Mailing address:
  • Phone: 702-804-1511
  • Fax: 702-804-2551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2900
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: