Healthcare Provider Details

I. General information

NPI: 1336152768
Provider Name (Legal Business Name): MISTY HURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 W RALPH HALL PKWY SUITE 207
ROCKWALL TX
75032-6658
US

IV. Provider business mailing address

121 WINDSOR
FORNEY TX
75126-4022
US

V. Phone/Fax

Practice location:
  • Phone: 972-772-6841
  • Fax:
Mailing address:
  • Phone: 972-564-1591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: