Healthcare Provider Details

I. General information

NPI: 1851953798
Provider Name (Legal Business Name): JOSEPH HURLEY ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W MALLON AVE
SPOKANE WA
99201-2134
US

IV. Provider business mailing address

700 W MALLON AVE
SPOKANE WA
99201-2134
US

V. Phone/Fax

Practice location:
  • Phone: 509-340-8399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00215400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT6913
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number003516-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT006357
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number60791435
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: