Healthcare Provider Details

I. General information

NPI: 1669734034
Provider Name (Legal Business Name): LAURA E HURLBERT PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA E BOEGEL PT, DPT

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 HOSPITAL DR STE 1008
WATERTOWN WI
53098-3320
US

IV. Provider business mailing address

18444 N 25TH AVE STE 310
PHOENIX AZ
85023-1266
US

V. Phone/Fax

Practice location:
  • Phone: 800-974-4378
  • Fax: 630-515-1536
Mailing address:
  • Phone: 623-434-2115
  • Fax: 623-544-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11840-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: