Healthcare Provider Details

I. General information

NPI: 1659113413
Provider Name (Legal Business Name): SHANTA N HURT LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 NW BROAD ST STE 203C
MURFREESBORO TN
37129-2324
US

IV. Provider business mailing address

2650 MERCHANTS WALK APT B201
MURFREESBORO TN
37128-2875
US

V. Phone/Fax

Practice location:
  • Phone: 615-710-8531
  • Fax:
Mailing address:
  • Phone: 615-624-1310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number8226
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: