Healthcare Provider Details

I. General information

NPI: 1447917935
Provider Name (Legal Business Name): ROBIN RENEE HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 11/19/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FLORENCE HEALTH SERVICES 5778 CHAPIN ST
FLORENCE WI
54121
US

IV. Provider business mailing address

N2032 BONNIE LN
MARINETTE WI
54143-9469
US

V. Phone/Fax

Practice location:
  • Phone: 715-528-4833
  • Fax:
Mailing address:
  • Phone: 434-825-8642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501020071
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305004352
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15646-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: