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General NPI Number Information
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NPI Number | 1811425713
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Entity Type | Individual
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Provider Name | LEO HURTADO PTA
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Gender | Male
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Dates
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Enumeration Date | 05/23/2017
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Last Update Date | 05/23/2017
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Provider Practice Location Address
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Address Line | 1540 6TH ST NW
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City | WINTER HAVEN
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State | FL
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Zip | 33881-2368
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Country | US
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Telephone | 863-294-3055
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Fax |
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Provider Business Mailing Address
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Address Line | 3081 GRAND PRESERVE BLVD
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City | MULBERRY
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State | FL
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Zip | 33860-0079
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Country | US
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Telephone |
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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 | PTA24219
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License Number State | FL
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