Healthcare Provider Details

I. General information

NPI: 1497033005
Provider Name (Legal Business Name): ALEX HURTADO P.T., D.P.T., N.C.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2011
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 CONESTOGA RD BUILDING 3, SUITE 114
BRYN MAWR PA
19010-1352
US

IV. Provider business mailing address

919 CONESTOGA RD BUILDING 3, SUITE 114
BRYN MAWR PA
19010-1352
US

V. Phone/Fax

Practice location:
  • Phone: 610-527-0178
  • Fax:
Mailing address:
  • Phone: 610-527-0178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT019511
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: