Healthcare Provider Details

I. General information

NPI: 1043799265
Provider Name (Legal Business Name): JESSICA RUTH HURLEY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 MUSTANG RD
ALVIN TX
77511-5012
US

IV. Provider business mailing address

314 LAKE LINE DR
ALVIN TX
77511-5153
US

V. Phone/Fax

Practice location:
  • Phone: 281-824-0070
  • Fax:
Mailing address:
  • Phone: 832-385-0904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2057540
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: