MEDICARE: STEPHEN P HURRLE P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	05001287A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000111107	OTHER	IN	ANTHEM BCBS PIN

General Provider Information

NPI Number	:	1760553960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN P HURRLE P.T.

Provider Business Mailing Address
First Line	:	1414 PARK MEADOW DR
Second Line	:
City	:	BEECH GROVE
State	:	IN
Zip	:	46107-1966
Country	:	US
Telephone Number	:	317-791-0049
Fax Number	:	317-791-0049

Provider Business Practice Location Address
First Line	:	1414 PARK MEADOW DR
Second Line	:
City	:	BEECH GROVE
State	:	IN
Zip	:	46107-1966
Country	:	US
Telephone Number	:	317-791-0049
Fax Number	:	317-791-0049

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2006
Last Update Date	:	07/08/2007

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