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General NPI Number Information
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NPI Number | 1629333968
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Entity Type | Individual
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Provider Name | KEVIN MICHAEL HURLEY DPT
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Gender | Male
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Dates
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Enumeration Date | 07/12/2012
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Last Update Date | 01/05/2017
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Provider Practice Location Address
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Address Line | 495 WINN WAY SUITE 250
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City | DECATUR
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State | GA
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Zip | 30030-1736
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Country | US
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Telephone | 404-294-1313
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Fax | 404-294-1318
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Provider Business Mailing Address
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Address Line | 495 WINN WAY SUITE 250
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City | DECATUR
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State | GA
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Zip | 30030-1736
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Country | US
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Telephone | 404-294-1313
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Fax | 404-294-1318
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT010690
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License Number State | GA
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