Provider Demographics
NPI:1659657187
Name:HURLBUT, JESSICA SUE (ATC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SUE
Last Name:HURLBUT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SAXON DR
Mailing Address - Street 2:MCLANE- ALFRED UNIVERSITY
Mailing Address - City:ALFRED
Mailing Address - State:NY
Mailing Address - Zip Code:14802-1205
Mailing Address - Country:US
Mailing Address - Phone:607-871-2916
Mailing Address - Fax:
Practice Address - Street 1:1 SAXON DR
Practice Address - Street 2:MCLANE- ALFRED UNIVERSITY
Practice Address - City:ALFRED
Practice Address - State:NY
Practice Address - Zip Code:14802-1205
Practice Address - Country:US
Practice Address - Phone:607-871-2916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001277-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer