Provider Demographics
NPI:1740618446
Name:HURT, MARISA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:HURT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7361 PRAIRIE FALCON RD STE 130
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0824
Mailing Address - Country:US
Mailing Address - Phone:702-804-1511
Mailing Address - Fax:702-804-2551
Practice Address - Street 1:7361 PRAIRIE FALCON RD STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0824
Practice Address - Country:US
Practice Address - Phone:702-804-1511
Practice Address - Fax:702-804-2551
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV29002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics