Healthcare Provider Details

I. General information

NPI: 1629380688
Provider Name (Legal Business Name): LYDIA HURTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15932 FM 442 RD
NEEDVILLE TX
77461-7114
US

IV. Provider business mailing address

15932 FM 442 RD
NEEDVILLE TX
77461-7114
US

V. Phone/Fax

Practice location:
  • Phone: 832-595-4037
  • Fax:
Mailing address:
  • Phone: 832-595-4037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2076590
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: