Healthcare Provider Details

I. General information

NPI: 1093064982
Provider Name (Legal Business Name): ANDREW CHRISTIAN HURST DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 W ROGERS BLVD SUITE 10
SKIATOOK OK
74070-4204
US

IV. Provider business mailing address

2416 HIGHWAY 45 N SUITE 10
COLUMBUS MS
39705-1320
US

V. Phone/Fax

Practice location:
  • Phone: 918-396-7125
  • Fax: 918-396-7186
Mailing address:
  • Phone: 662-327-6705
  • Fax: 662-327-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4634
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: