Healthcare Provider Details

I. General information

NPI: 1023786761
Provider Name (Legal Business Name): WHITNEY LAUREN HURLBURT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 BROAD ST
GLENS FALLS NY
12801-4301
US

IV. Provider business mailing address

9 BROAD ST
GLENS FALLS NY
12801-4301
US

V. Phone/Fax

Practice location:
  • Phone: 518-409-4288
  • Fax:
Mailing address:
  • Phone: 518-409-4288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number012976
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: