Healthcare Provider Details

I. General information

NPI: 1851389068
Provider Name (Legal Business Name): LAURAYNE PITTMAN HURST PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: LAURIE PITTMAN HURST PT

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 NE STALLINGS DR
NACOGDOCHES TX
75965-1254
US

IV. Provider business mailing address

319 W LAKEWOOD ST
NACOGDOCHES TX
75965-2420
US

V. Phone/Fax

Practice location:
  • Phone: 936-568-3158
  • Fax: 936-568-3271
Mailing address:
  • Phone: 936-569-6776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1016152
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: