Healthcare Provider Details

I. General information

NPI: 1013295302
Provider Name (Legal Business Name): ANTHONY HURT P.T.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 N MACARTHUR BLVD SUITE 100
IRVING TX
75061-2221
US

IV. Provider business mailing address

2120 N MACARTHUR BLVD SUITE 100
IRVING TX
75061-2221
US

V. Phone/Fax

Practice location:
  • Phone: 972-438-3800
  • Fax: 214-614-4496
Mailing address:
  • Phone: 972-438-3800
  • Fax: 214-614-4496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2035004
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: