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General NPI Number Information
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NPI Number | 1043799265
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Entity Type | Individual
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Provider Name | JESSICA RUTH HURLEY PTA
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Gender | Female
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 08/08/2018
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Provider Practice Location Address
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Address Line | 3830 MUSTANG RD
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City | ALVIN
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State | TX
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Zip | 77511-5012
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Country | US
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Telephone | 281-824-0070
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Fax |
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Provider Business Mailing Address
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Address Line | 314 LAKE LINE DR
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City | ALVIN
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State | TX
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Zip | 77511-5153
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Country | US
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Telephone | 832-385-0904
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2057540
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License Number State | TX
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