Healthcare Provider Details

I. General information

NPI: 1427489871
Provider Name (Legal Business Name): MICHAEL P HURLEY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3799 12TH STREET EXT STE 100
CAYCE SC
29033-3750
US

IV. Provider business mailing address

PO BOX 6069
WEST COLUMBIA SC
29171-6069
US

V. Phone/Fax

Practice location:
  • Phone: 803-926-6810
  • Fax:
Mailing address:
  • Phone: 803-935-8292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305208452
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7983
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: