Provider Demographics
NPI:1285681403
Name:HURST, LAWRENCE HOSMER (PT)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:HOSMER
Last Name:HURST
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1826
Mailing Address - Country:US
Mailing Address - Phone:760-922-8400
Mailing Address - Fax:760-922-8401
Practice Address - Street 1:1111 W HOBSONWAY
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1421
Practice Address - Country:US
Practice Address - Phone:760-922-8400
Practice Address - Fax:760-922-8401
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17230225100000X
AZ2232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT172300OtherPPIN
CAZZZ26146ZMedicare ID - Type UnspecifiedGROUP ID