Provider Demographics
NPI:1033487087
Name:HURLEY, BETH A (LMT, CPMT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:HURLEY
Suffix:
Gender:F
Credentials:LMT, CPMT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:A
Other - Last Name:MULCAHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1550 SE COCHRAN DR
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-9274
Mailing Address - Country:US
Mailing Address - Phone:503-724-5771
Mailing Address - Fax:
Practice Address - Street 1:1550 SE COCHRAN DR
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-9274
Practice Address - Country:US
Practice Address - Phone:503-724-5771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18327225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist