Healthcare Provider Details

I. General information

NPI: 1437588654
Provider Name (Legal Business Name): ROBIN HURLEY LPTA, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4992 MARSHLAKE LN
DUMFRIES VA
22025-1226
US

IV. Provider business mailing address

4992 MARSHLAKE LN
DUMFRIES VA
22025-1226
US

V. Phone/Fax

Practice location:
  • Phone: 703-371-0550
  • Fax:
Mailing address:
  • Phone: 703-371-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019018399
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306602379
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: