Healthcare Provider Details

I. General information

NPI: 1245620186
Provider Name (Legal Business Name): RUTH HURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1476 LONG GROVE DR
MT PLEASANT SC
29464-7571
US

IV. Provider business mailing address

3171 PIGNATELLI CRES
MOUNT PLEASANT SC
29466-8058
US

V. Phone/Fax

Practice location:
  • Phone: 843-216-3534
  • Fax: 843-216-3576
Mailing address:
  • Phone: 908-334-8047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6602
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: