Provider Demographics
NPI:1760553960
Name:HURRLE, STEPHEN P (PT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:HURRLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 PARK MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:BEECH GROVE
Mailing Address - State:IN
Mailing Address - Zip Code:46107-1966
Mailing Address - Country:US
Mailing Address - Phone:317-791-0049
Mailing Address - Fax:317-791-0049
Practice Address - Street 1:1414 PARK MEADOW DR
Practice Address - Street 2:
Practice Address - City:BEECH GROVE
Practice Address - State:IN
Practice Address - Zip Code:46107-1966
Practice Address - Country:US
Practice Address - Phone:317-791-0049
Practice Address - Fax:317-791-0049
Is Sole Proprietor?:No
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001287A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000111107OtherANTHEM BCBS PIN
IN675070AMedicare ID - Type UnspecifiedPROVIDER NUMBER