Provider Demographics
NPI:1043799265
Name:HURLEY, JESSICA RUTH (PTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RUTH
Last Name:HURLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 LAKE LINE DR
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-5153
Mailing Address - Country:US
Mailing Address - Phone:832-385-0904
Mailing Address - Fax:
Practice Address - Street 1:3830 MUSTANG RD
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-5012
Practice Address - Country:US
Practice Address - Phone:281-824-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2057540225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant