Provider Demographics
NPI:1639573397
Name:HURT, MARIAN PEREZ (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:MARIAN
Middle Name:PEREZ
Last Name:HURT
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 N. SPRIGG
Mailing Address - Street 2:RATLIFF CARE CENTER
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701
Mailing Address - Country:US
Mailing Address - Phone:573-335-7662
Mailing Address - Fax:573-335-7662
Practice Address - Street 1:2001 N. KINGSHIGHWAY
Practice Address - Street 2:FOUNTAINBLEAU LODGE
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701
Practice Address - Country:US
Practice Address - Phone:573-335-1999
Practice Address - Fax:573-651-6065
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist