Provider Demographics
NPI:1629380688
Name:HURTA, LYDIA
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:HURTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15932 FM 442 RD
Mailing Address - Street 2:
Mailing Address - City:NEEDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77461-7114
Mailing Address - Country:US
Mailing Address - Phone:832-595-4037
Mailing Address - Fax:
Practice Address - Street 1:15932 FM 442 RD
Practice Address - Street 2:
Practice Address - City:NEEDVILLE
Practice Address - State:TX
Practice Address - Zip Code:77461-7114
Practice Address - Country:US
Practice Address - Phone:832-595-4037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2076590225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant