Provider Demographics
NPI:1326713009
Name:HURTT, TROY EUGENE (LMT)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:EUGENE
Last Name:HURTT
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 W CLEVELAND RD STE B
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-5638
Mailing Address - Country:US
Mailing Address - Phone:574-271-8424
Mailing Address - Fax:574-271-8425
Practice Address - Street 1:418 W CLEVELAND RD STE B
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-5638
Practice Address - Country:US
Practice Address - Phone:574-271-8424
Practice Address - Fax:574-271-8425
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT21906772225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist