Provider Demographics
NPI:1154462448
Name:HURTAK, LORETTA N (PT)
Entity Type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:N
Last Name:HURTAK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:N
Other - Last Name:HURTAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:11848 STONEBRIDGE DR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1886
Mailing Address - Country:US
Mailing Address - Phone:904-880-1788
Mailing Address - Fax:
Practice Address - Street 1:11701 SAN JOSE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-0756
Practice Address - Country:US
Practice Address - Phone:904-858-7450
Practice Address - Fax:904-858-7451
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist